Care Home: Lightmoor View

What the care home does well Information is available to people looking to move into Lightmoor View to enable them to make an informed decision as to whether the home can meet their needs, this assisted by the checks that staff do before admission. Care is provided in a way that respects the individual and shows respect for people`s privacy and dignity. Contact between people living at the home and significant others is promoted and staff work hard to promote people`s chosen day to day routines. The home provides a choice of meals that reflect individual peoples nutritional needs, this reflecting the homes achievement of Shropshire`s Healthy Eating Platinum award and its 5 star rating for Food Hygiene from Environmental Health. The home promotes practices and information that safe guard vulnerable adults and learns from any issues from complaints and matters related to protection of individuals. Management have numerous ways of gathering the views of people living at the home, their relatives and health and social care professionals. Medication management is well developed with robust checks in place. The building reflects the value the organization puts on quality care in providing a well designed and maintained environment that assists the meeting of people`s needs in a way that promotes privacy and dignity. The management of the home listens to the views of people using the service, and uses appropriate tools to assess their satisfaction where people may not be able to communicate these. People told us that: `The care is excellent, I am so happy to have my mother there as I can relax knowing she is well looked after as she cannot do anything for herself and the staff are wonderful`. `Personal care for patients - residents is of a very high standard`. `Quality service to older people with complex mental health needs`. `have witnessed excellent palliative care`. What has improved since the last inspection? This is the first main inspection of Lightmoor view, therefore improvements we have seen are limited to what has been put in place since the home has opened. In this short space of time there have been improvements in staffing levels so as to increase their availability to people living in the home and thereby improve outcomes. The move for people living at Lincoln Grange and the staff team has been a huge undertaking and involved much work, especially as there has been numerous admissions with Lightmoor View having more places. This has involved recruitment of more staff which has the potential to unsettle the consistency of care. This was a concern of the management and they have countered this through consolidating the staff team and listening to people as to how they can improve the service. We have also heard of a training scheme developed by the home in regard to dementia care, this accredited by the Royal College of Nursing, this formulated to help people look at their values when caring for people with dementia. We have heard some differing views as to the success of the transition of the service to Lighmoor View such as: `since moving to the new site the staffing I think was an issue, several new staff were working at the same time and the fact that they were new faces for the residents to get used to and the new staff were not aware of the resident`s idiosyncrasies caused alot of anxiety` and `I believe the transition from Lincoln Grange into Lightmoor View was handled extremely well`. We have however seen a mostly positive view of the service based on what people living at the home, their relatives and health and social care professionals have told us, this building on the track record of excellence that we saw at Lincoln Grange. What the care home could do better: The management of the home has clearly identified and in some cases actioned areas where there is scope for improvement, having told us about these in written information they have sent to us or at the time of our visits. With some limited exceptions this includes: The need for more robust assessment of care files to ensure they reflect the current requirements of the individual. The management have systems that they are looking to introduce to address this and are also reviewing the formats of care plans so as to make them easier to understand for people with dementia. Better monitoring of the individual activities people are involved with on a day to day basis also needs to take place. Use of an admission checklist to ensure peoples preferences are captured at the point of admission and that all checks are recorded so that managers know they are completed. More signage to point to such as toilets and differing coloured areas to assist with orientation around the home, this something the manager is aware of, and considering. To consider the provision of opening windows in the lounge/dining areas of the home to assist with ventilation and the suitability of pathways in the gardens for wheelchairs when a number of people are using these. Key inspection report Care homes for older people Name: Address: Lightmoor View Brick Kiln Lane Lightmoor Telford Shropshire TF7 5LH     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: Jonathan Potts     Date: 1 1 1 2 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: Lightmoor View Brick Kiln Lane Lightmoor Telford Shropshire TF7 5LH 01952433909 01952433980 lightmoor@coveragecareservices.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Coverage Care Services Name of registered manager (if applicable) Mrs Julie Roberts Type of registration: Number of places registered: care home 75 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: 1. The registered person may provide the following category of service only: Care home with nursing (Code N) To service users of the following code or gender: Both. Whose primary care needs on admission to the home are within the following categories: Dementia - (DE) 75. 2. The maximum number of service users who can be accommodated is: 75 Date of last inspection Brief description of the care home Coverage Care Services Ltd is a local provider which operates a number of other registered care services in the Telford and Wrekin area. Lightmoor View is a new build care home with nursing, that will accommodate up to 75 service users who have a Dementia related condition, and has replaced the service Coverage Care Services Ltd provided previousy at Lincoln Grange, this as the environment at Lincoln Grange was deemed unsuitable and the building of Lightmoor Care Homes for Older People Page 4 of 32 Over 65 75 0 Brief description of the care home was planned by the company to provide existing service users access to a much improved environment. The accommodation consists of an imposing detached and spacious property that is accessed via a slip road with car parking space available. The care home offers 75 single occupancy rooms across 3 floors. The rooms provide ensuite toilets with shower facilities. People live in units of 12-13 people of which there are two units on each of the three floors. These units consist of a combined living/dining room with separate kitchenette. The property also offers service users a small quiet area away from each of the communal lounges. The home has a range of aids availabe such as lifts, adapted bathing faclities, loop system (for the hearing impaired) and call systems. A large communal room for celebrations and functions is located on the first floor with a kitchenette facility attached and library area and internet cafe planned. Mrs J Roberts is the General Manager and is responsible for the day-to-day running of the home, and is supported by a Nurse manager who is able to assist with the clinical/nursing aspects of the care provided at Lightmoor. There are nursing and care staff available throughout the day and night, these supported by a range of ancillary staff including housekeepers, cooks and such like. The fees for the home range from £730 per week inclusive of nursing care allowance. This information is detailed in the homes information packs. 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: 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: We did not tell the home we were going to visit , and arrived at Lightmoor View at 9.30am on the 7th December 2009. We also visited the home on the 11th December to conclude our inspection. The visit was carried out by one of inspectors. Before we visited the home we reviewed all the information we had received about it since its registration, this including information sent to us by the homes manager (this in a document called an Annual Quality Assurance Assessment - AQAA). We also reviewed all the other information we have received about the home, this including that from the home (in the form of notifications about such as incidents that they have to legally tell us about) and from other organisations. We also considered the information we gathered through the process by which we registered the home, which involved a visit to the home and interview with the manager. We also sent out Survey forms. We received a number of these back, eight from relatives or representatives of people living at the home and eight from health and social care professionals. Care Homes for Older People Page 6 of 32 We spoke to four people who live at the home, five staff, the registered manager and the nurse manger during our visit. We also looked at care and management records as well as having a look around the building. This is the first main inspection of the home since the service transferred from Lincoln Grange. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? This is the first main inspection of Lightmoor view, therefore improvements we have seen are limited to what has been put in place since the home has opened. In this short space of time there have been improvements in staffing levels so as to increase their availability to people living in the home and thereby improve outcomes. The move for people living at Lincoln Grange and the staff team has been a huge undertaking and involved much work, especially as there has been numerous admissions with Lightmoor View having more places. This has involved recruitment of more staff which has the potential to unsettle the consistency of care. This was a concern of the management and they have countered this through consolidating the staff team and listening to people as to how they can improve the service. We have also heard of a training scheme developed by the home in regard to dementia care, this accredited by the Royal College of Nursing, this formulated to help people Care Homes for Older People Page 8 of 32 look at their values when caring for people with dementia. We have heard some differing views as to the success of the transition of the service to Lighmoor View such as: since moving to the new site the staffing I think was an issue, several new staff were working at the same time and the fact that they were new faces for the residents to get used to and the new staff were not aware of the residents idiosyncrasies caused alot of anxiety and I believe the transition from Lincoln Grange into Lightmoor View was handled extremely well. We have however seen a mostly positive view of the service based on what people living at the home, their relatives and health and social care professionals have told us, this building on the track record of excellence that we saw at Lincoln Grange. 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. People who are looking for a service from Lightmoor have access to sufficient and suitable information prior to admission, this ensuring that their needs are identified and that their move into the home is well managed. Evidence: We looked at the information available within the home for prospective users of the service and found that this was readily available in the foyer of the home, with a number of copies of the homes statement of purpose and service users guide that people could pick up and take with them. This was supplemented by a welcome guide which we saw contained information about the service Lightmoor View offered, and other information of use such as how to pay for care. For people who are able to access the companies website there is also information online as to the company and the services they offer people at various sites. People can also contact the company through this website. Eight relatives that responded to our surveys said that there was always or usually enough information available about the home for them to make Care Homes for Older People Page 11 of 32 Evidence: decisions. People we spoke to at the time of our visits to the home also told us that they had received sufficient information about the home prior to their relative moving in, this including pre admission visits. The manager told us that they invite people to visit so that they can view the facilities and its suitability to their needs, as well as chat with other people living at the home, this so as to ensure a smooth transition from home/hospital into Lightmoor View. We looked at the assessment(checks) and admission information relating to five people living at the home, some of these recent admissions. In all instances we saw that the home had identified clearly what the needs of the people moving into the home are, this supported by use of information from such as social workers and hospitals and with the involvement of the person receiving the care and/or their representatives, with their input fully recorded. Seven health and social care professionals that responded to our surveys told us that the homes checks always or usually ensure that accurate information is obtained about people living at the home, and as a result the right service is provided. What we found at the time of our visits supported the statement the manager made in information sent to us prior to our visit, this stating that they undertake comprehensive checks of all service users needs prior to admission so as to ensure they are able to meet these. We heard from peoples representatives that they have information provided before moving into the home although we did suggest that the use of an admission checklist maybe useful to ensure all pre admission tasks are carried out (such as providing a service users guide, asking about specific preferences and such like), this then available as evidence for such as quality control. We saw that the home has suitable contracts in place between themselves and people using the service, copies of these seen to be kept on individuals files and agreed by the individual or their representative. Care Homes for Older People Page 12 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. The home provides individuals with care that meets their personal and health care needs whilst respecting their individuality. Staff show regard to the privacy and dignity of the people living at the home in the way they care for them. Evidence: We looked at the care plans the home has drawn up for five individuals living at the home. These we found documented the full range of a persons needs and when we compared them to checks that had been carried out with individuals, these plans of care reflected the information that the staff had gathered with little exception, although there was very limited instances where review had not resulted in update of the plan (examples included reference to the need to maintain records of a persons behaviour when not necessary and more frequent monitoring of blood glucose levels than was needed). Discussion with the management at the time led to comment as to the introduction of a care plan audit form (a copy of which was shown to us) to ensure these minor errors are picked up through checks. This did not however detract from the fact that the plans of individuals care are easy to follow and overall reflected what people/their representatives or staff told what care was given. Care Homes for Older People Page 13 of 32 Evidence: We observed general interaction between staff and individuals living at the home and judged what we saw to be positive examples including staff transferring an individual with use of a hoist and sitting and chating to individuals. Whilst undertaking the transfer of the individual we saw staff talking to the person, telling them what they were doing and checking that the individual was OK. There are a number of staff at the home trained in dementia mapping, this involving staff observing individuals through a set period to ascertain their state of mind and make a judgment as to whether they are involved in positive interactions with staff and others. The reports we saw of this observation showed numerous examples of positive practice, but also some interactions that indicated where there was scope for staff to improve; this seen by management as a tool to improve the quality of their service to individuals. There have been some issues identified with record keeping that the management informed us of and they were also clear as to the steps they are putting in place to ensure these improve. We received comments as to the standard of care from relatives and health professionals such as the following: The care is excellent, I am so happy to have my mother there as I can relax knowing she is well looked after as she cannot do anything for herself and the staff are wonderful. Personal care for patients - residents is of a very high standard. Quality service to older people with complex mental health needs. Eight relatives who responded to our surveys said that individuals living at the home always or usually had the support that was expected or agreed, that staff had the right skills and that they responded to the differing needs of people. We looked at the health care provision for five individuals from external health services and found that individuals accessed these as and when needed. We saw that when the home needed advice they used external health services appropriately. Eight health and social care professionals that responded to our surveys stated that peoples health and social care needs are always or usually properly monitored or reviewed by staff at Lightmoor View. In addition they told us that the home always or usually seeks advice and acts on it so as to meet peoples needs and by so doing improve their well being. We saw in all the records we looked at that there was robust record keeping in respect of such as nutrition, skin integrity and risk from falls, these seen to inform the individuals plan of care. We saw that the home has an efficient medication policy, procedure and practical guidance. We saw this is readily accessible to staff and we looked at a number of audit systems the nurse manager has put in place that verify it is followed. These include general checks on medication as well as observation of staff administering drugs on a Care Homes for Older People Page 14 of 32 Evidence: regular basis, these checks fully documented. Discussion with the nurse manager showed us that she saw the monitoring of medication of vital importance due to the potential of harm should there be errors, and she underlined the constant need to be vigilant and ensure complacency was not tolerated. Having looked at the recording, monitoring and storage of medication within the home we found this to be of high quality, this including the handling of controlled medications where present. Systems for the monitoring of medication held by the home, and disposal are also in good order. We saw that the building promotes privacy and dignity with all single bedrooms, ample space for privacy and en suites showers in every bedroom. The individuals care plans also promote the need for practices that promote individual care, independence and dignity with reference to specific issues of importance to the person concerned, this including communication where necessary. We saw that people where able are able to move freely, although if there are any restrictions due to safety these we saw are well documented, with the reasons why and how staff work to ensure the least restrictive methods are used. One professional who visits the home told us that the care home has well trained nursing staff who are caring and compassionate and respect residents privacy and dignity The management told us of there work toward the gold standard for palliative care and we received one comment from a visiting professional that they have witnessed excellent palliative care. Care Homes for Older People Page 15 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. The home works hard to promote peoples access to their chosen daily routines and provide people with a stimulating environment. People are enabled to keep in contact with their relatives, friends and representatives. Individuals dietary needs are well catered for through provision of a an appropriate selection of meals. Evidence: We looked at five care plans in respect of how the home promotes an individuals chosen daily routines and found that these told us how care should be provided so that individuals independence and preferences are promoted. The way in which this was done was confirmed as accurate, and as agreed, by checking other records, discussion with individuals, staff and observation during the time of our visits. The home has an allocated activity organiser post, although the post holder was at the time of our visits on extended leave. The manager was looking at other staff undertaking this post to ensure any emphasis on activities for individuals within the home was not lost. We looked at photographic records relating to events that the home has held, this including such as visiting donkeys and other animals, crafts, tea dances and a trip out to Cosford aerospace museum (this on significance for one individual living at the home due to links with the RAF). We also spoke to a lay pastor who was preparing for a service in the homes common room (The Acorns). He Care Homes for Older People Page 16 of 32 Evidence: confirmed that he offers regular service to any denomination of faith and as he gets to know people has been asked to officiate at funerals by some relatives. The building is designed to assist with the provision of day time activities examples including ample space throughout, a separate hairdressers room and the communal Acorns room which is utilized for such as social events involving individuals from all the separate living units in the home. The manager told us of plans to extend the use of the room through liaison with community organizations such as the Alzheimers society, with such as drop in sessions. The Acorns is already host to monthly luncheon clubs and tea dances. We saw that care had been taken by staff to assist with individuals personal presentation (for examples painted nails, clean glasses and clothing). We also saw a number of occasions where staff were sitting talking to people. We received one comment that TVs are sometimes left on when people are not watching them (tuned into childrens programmes) although we saw no evidence of this on the two days of our visits. The manager was aware this may have been an issue on occasion and would be resolved if found to be happening. Comments we received from eight health and social care professionals stated that three thought the home always, and five usually supported individuals to live the life that they choose. Eight relatives who responded to surveys stated that the home always (3) or usually (5) responded to the differing needs of people. We did hear some comments however that indicated there have been times when there could be more stimulation, with another relative stating that the carers are very rushed and a lot of the patients are relying on the carers to do everything for them. We have however heard about the efforts staff have made to promote stimulation and the manager has secured a recent increase in staffing hours to assist with the time carers have available. One relative commented that the home encourages residents to achieve their full potential no matter how limited their potential is. Whilst we judged that the individual activities people are involved with could be better recorded by staff (to enable a better picture of any meaningful activities people are involved with on a daily basis), the use of observational tools by staff to monitor positive interactions and peoples state of wellbeing we saw to be useful in giving management a snapshot of what life is like for people at the home, and where the home does well, or could improve. This process is called dementia care mapping and we saw that a number of staff are trained in its use. We have been told by relatives through surveys that the home is good at keeping them up to date with developments, and helping the people living at the home keep in Care Homes for Older People Page 17 of 32 Evidence: touch with them. Comments made to us included the following: usually open and welcoming when I visit, support me as well as husband and a big thank you from all my family for caring and making my mother happy as well for the support you have shown us as a family. We saw the homes visiting policy and the contents of this have been confirmed by what people told us in that there are no restrictions on visiting, and hospitality was available (for example they could make themselves drinks and meals are available to visitors). The manager told us that she sees the main meal of the day as a highlight as well as an important social occasion. We saw that a choice of meals is available, this advertised on the day through use of display cards on the dining room tables. In addition we saw that each unit has a book of photos of the meals that are available this to assist staff in explaining available meal choices. From sight of five case files we saw that individuals specific nutritional needs are explored through planning and nutritional checks that inform the delivery of a personalized service. We saw that the meals available on the days of our visits matched those advertised on the menus, with a choice available. We saw that meals times are relaxed and unhurried, with this supporting the homes own findings for its observational sessions. People we spoke to on the day said that they had enjoyed their meals and we saw that staff supported more dependent individuals to eat appropriately. Whilst we received limited comment as to the need for a more varied menu through our surveys of relatives this was not supported by what people told us during our visits. We looked at the homes menus and saw that these show a variety of available meals, and we saw certification to evidence that the home has achieved Shropshires Healthy Eating Platinum award (assessment of healthy food choices, smoke free facilities, compliance with Food safety and staff training). The home also has a 5 star rating for Food Hygiene from Environmental Health. Care Homes for Older People Page 18 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 tell us they are aware of the homes complaints procedure and the home responds appropriately to complaints. Practices at the home safeguard and protect the individuals living there. Evidence: We saw that the home has a clear complaints procedure available within the home, this including timescales in which complaints will be dealt with. Out of eight relatives that responded to our surveys seven stated they were aware of the homes complaints procedure, only one saying that they did not know about it. In addition five said that the home responded appropriately if concerns are raised, two saying this was usually the case. Out of eight health and social care professionals that responded to our surveys four said the home responded appropriately when concerns are raised, three saying this was usually the case and one sometimes. We looked at the homes records in respect of any concerns, complaints or allegations that have been raised since the home opened and found these to be well documented, with a clear trail of information in respect of outcomes, that included evidence relating to how the service had responded and learnt from these, this so as to ensure no re-ocurrence and improvement. Discussion with the management of the home indicated that they are knowledgeable as now to handle complaints and concerns and viewed the receipt of complaints as a valuable opportunity to learn and improve the service that they offer. We heard how Care Homes for Older People Page 19 of 32 Evidence: the management looked to use other agencies to assist them with improving the service and expressed an openness to receipt of constructive criticism, and they told us how they have learnt from any outcomes from safeguarding referrals. The home has kept us fully informed of any allegations that have arisen at the home. The management and staff are well aware of the need to raise any allegations with social services, and we saw that there was clear evidence that this has been done appropriately. Adult protection awareness is part of the staff induction process. We have also seen evidence that the home has co-operated fully with other statutory agencies in assisting investigations and participating in an strategy meetings. Outcomes from action points following such have been clearly communicated to staff through such as staff meetings and supervision. We saw that the home has policies and procedures in place to protect peoples finances, and there is secure storage for any monies safe kept for individuals by the home. We saw that staff sign the homes gifts and gratuities policy to indicate their understanding and awareness, and we noted that this has been updated to reflect the fact that staff must not benefit from such as supermarket loyalty cards and buy one get one free offers when shopping for individuals living at the home. Recording we saw relating to individuals valuables in safekeeping was up to date and accurate and reflected what we found was in safekeeping when we did spot checks. We looked at inventories for property for five people, these accurate when sampled, with only one omission found (which was corrected). From sight of an individuals records we saw that the management had referred an issue that they were concerned may involve a deprivation of liberty to the local authority in timely manner. The decision by the local authority that it was a restriction we saw was evidenced by documentation from the social service department and the home has worked with them to ensure that care is provided in the least restrictive way when ensuring a individual is safe. Discussion with the manager and deputy showed us that they had a good understanding of the mental capacity act and what may and may not be a deprivation of liberty. Care Homes for Older People Page 20 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 home provides an environment that is well designed so that it is suitable for meeting the needs of those people that live there, thus promoting privacy, dignity and independence. Infection control receives a high priority, thus protecting the health of people living at the home. Evidence: Lightmoor View is a large detached purpose built home that is accessed via a slip road, and has car parking available on site. The management told us how their views had been taken into account in the design of the building, and we saw that thought had been given as to how to enable the provision of good care in the design. The home has six living units which comprise of a number of bedrooms, one bathroom (with adapted bath to give choice if people do not wish to shower), and a large kitchenette/dining room/lounge, as well as service areas. All bedrooms are of a good size and are single en suites with floor level shower facilities, this enhancing privacy and enabling dignity. The corridors are wide and spacious and are fitted with handrails throughout. We saw that there are pictorial signs for such as bathrooms and toilets with some individuals having individual displays on their bedroom doors. We saw that the corridors are all the same colour however would benefit from some variation, this an issue the manager was fully aware of and looking to address in the future. The home has a feeling of space and people living there are able move around the units freely where able, with an additional seating area at the end of the corridors for Care Homes for Older People Page 21 of 32 Evidence: people to sit, this with a fair amount of privacy. The areas of the home we saw are very clean, well decorated and some of the bedrooms had been personalized by the occupants. We saw that the ground floor units have access to an external recreational space that includes a path and seating with wooden gazebo. Whilst the manager told us they are looking to develop this further (in more clement weather) we heard one comment to the fact that the pathways would benefit from widening to assist traversing the path with a wheelchair, especially when others are using the same path. Thought has been given to access to fresh air on the 1st and 2nd floor units and there is easy access to a large balcony (with glass safety barriers) that allow a good outlook. We saw that plants have been placed in these areas in pots and there was ample seating. The lounge/dining areas have a full fitted kitchenette where snacks can be prepared by people where they are able and there are tea and coffee making facilities that can be used by visitors. The units throughout the home we saw to be pleasant and homely areas, although there was one issue that a relative brought to our attention via a survey form, in that the windows in the rooms do not have an opener, this detracting from the availability of ventilation. Currently the only way to ventilate the room is to open the patio door. It was pleasing to see that these rooms have a loop system fitted for people who have hearing aids fitted. We also noted that all windows at at a height that allows people to look out of them whilst sitting down and toilets/bathrooms are fitted with motion sensor lights that switch on as soon as someone enters, potentially detracting from accidents if people are trying to find a light switch. As well as the living areas of the home, which are accessed via security key-padded doors the home has a spacious foyer and on the 1st floor a large communal area that is use for functions, and storage of the homes DVD and CD library (this for individuals to access and use). Off this room there is a separate hairdressing room. The building has been designed so that the main service areas such as kitchen, office and laundry are separate so that any activity involved with work in these areas does not intrude into the units where people live. We did however see that the units do have discrete and ample storage for such as medication and equipment with a separate nurses station that whilst not overlooking communal living areas is close enough for staff to be readily accessible. There is also secure records storage to hand for staff. We looked at records relating to the upkeep and maintainence of the building as completed by the staff (such as water temperature checks) and external contractors Care Homes for Older People Page 22 of 32 Evidence: and these showed that the building is well maintained and safe. Any minor works are actioned by one of the two handymen employed at the site. People told us that they liked the building and the environment it offered comments including the following: being a new home it is always spotlessly clean as are the bedrooms etc, lovely place, nice setting and I like the fact it is split into smaller units each with their own staff making it a friendly homely atmosphere. We saw the homes procedures for infection control and the last audit that management had carried out in April 2009, this informing the steps the home has taken to maintain infection control. The manager/deputy showed us the homes risk assessments and explained the precautions the home took to manage infection, these judged to be robust. The only issue in respect of infection control that we noted was that pillows were stored on the floor in one cupboard. The manager assured us that this will be addressed. 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. The staff at the home are well trained and available in sufficient numbers following a recent increase in numbers, this so as to improve the support people living at the home have. Robust recruitment practices protect people living at the home. Evidence: We looked at the homes staffing rotas and found these to be clear detailing the hours all staff work, this including the nursing and management. The home has built up the staff team since opening, the management fully aware of the need to try and maintain the consistency of the staff. The number of staff we saw around the home and on each unit accorded with the staffing levels detailed in the rotas we looked at. The management also allocate staff to a set unit within the home, and wherever possible try to ensure that the staff member works with the same group of people so as to ensure that they know the carer well, and recognize them. We saw that the home has sufficient cover in respect of nursing staff. There have been some difficulties with staffing that the manager was open about, in that when there are numerous people moving into the home following opening it has taken time to get to know people, what their needs are and what implications this has for staffing levels, this lessened to a degree by the homes robust assessment processes. There has also been difficult with the management getting to know new Care Homes for Older People Page 24 of 32 Evidence: staff that have been employed, although there has been a core of established staff that moved to Lightmoor from Lincoln Grange (which was the home that Lincoln has replaced). The issues have been reflected in comments we have recieved from relatives such as since moving to the new site the staffing I think was an issue, several new staff were working at the same time and the fact that they were new faces for the residents to get used to and the new staff were not aware of the residents idiosyncrasies caused alot of anxiety, I sometimes think that they do not have enough carers on site to look after all the people on their floors as sometimes the carers are very rushed and a lot of patients are relying on carers to do everything for them. So if you have more than one patient needs toilet, eat it is hard for carers to see to all and patients get frustrated having to wait, I have concerns about staffing levels in recent weeks, there have been many occasions when there has only been one member of staff on the unit for periods of up to two hours when I have been visiting. These views do not however detract from what people said about the care and staff with comments like the care is excellent, personal care for patients residents is of a very high standard and the care is the best could wish for. These later comments are reflected by health and social care professionals who have stated home has well trained nursing staff who are caring and compassionate and respect residents privacy and dignity ,good numbers of qualified staff and provide quality service to older people with complex mental health needs. We did raise staffing levels as a matter for discussion with the manager at the time of our visit and have been told, and shown that the staffing has increased based on the homes assessment of individuals needs in the home, this responding to the views of people that have an interest in the service. This underlines that the service has responded to an issues that may have risen in respect of staffing levels since opening. We looked at staff files these including staff that have been recruited recently and we found these in good order with clear evidence available of the home carrying out robust recruitment checks in accordance with its recruitment policy and our expectations. We also saw robust arrangements in place to ensure that staff are appropriately inducted to the home, this so that they know what they need to do and what their job involves (as detailed in their job description). We looked at the homes overview of training for all staff and this shows a good input that builds on in house training in mandatory areas and includes areas such as dementia care and nutrition. Managers have taken part in the majority of this training so that knowledge is available within the staff group and underlines the good outcomes we found. The recording of the training staff have is in the process of transfer to new computer software although the information we asked for was made Care Homes for Older People Page 25 of 32 Evidence: available. The certificates of training we saw in the four staff files we looked at accorded with training records and also indicated that bank staff are included in the homes training plan. Discussion with the management showed us that they have a commitment to training and consider the relevance of such in improving outcomes for people living at the home, this assisted by regular appraisals of staff. An example of this is the wish to train more staff in dementia care mapping, this a useful tool in assessing the state of peoples well being and therefore outcomes. The home has also developed its own dementia care training for care staff called who do you see that looks at the value base for staff working with people with dementia. This training has been accredited by the Royal College of Nursing and is to be offered to other services. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home consults with people who live at the home and others to inform the management of the service, this so that it reflects their views. The home is well managed by staff that have proven leadership skills and the confidence of those people that use the service. Evidence: We looked at the home certificate of registration at the time we visited the home (this on public display) and this reflected the information we have about the home, evidencing that the one on display is current. The homes registration is reflected in the homes statement of purpose where it is stated as to what service the home offers and to whom. From information provided to us by the home and feedback we have received the home is not accommodating any people whose needs they are unable to meet. The registered manager of the home, Julie Roberts moved to Lightmoor View with the residents from Lincoln Grange and has demonstrated to us when we registered her as Care Homes for Older People Page 27 of 32 Evidence: manager early in 2008 that she has extensive experience and the appropriate management qualifications to manage the home well. Julie Roberts is not a nurse manager, but has an experienced and well practiced nurse as a deputy manager, this to take a lead on any clinical issues under their direction. Both the manager and the deputy (nurse manager) have demonstrated to us that they both have a breadth of knowledge and experience that means they know how to ensure there is good outcomes for people living at the home, as demonstrated through comments earlier in this report and further supported by the following statements by relatives and health and social care professionals : The service provides support to carers that is highly valued, development over recent months into a well functioning home has been a real asset to meet needs of clients within Telford and Wrekin , No complaints on management and staff, Ive found (the deputy) more than helpful and excellent communication with health professionals including establishment of consultant led clinic. We saw that the Coverage Cares senior managers review the conduct of the home on a regular basis through monthly monitoring visits, as well as management meetings, some of these focusing on specific areas (such as health and safety). Quality monitoring takes place on an on going basis through in house audits, meetings (with people that live at the home and staff) and day to day contact between the manager and people living at the home, their visitors (as we saw during our visit) and staff, this to ensure that the views of people are reflected in the running of the service. We saw that the home uses its own annual surveys to canvas the views of the people that use the service as well as their representatives, the summary of the findings (these from Lincoln Grange) included in the homes service users guide (these seen to reflect some very positive outcomes). Whilst there are some areas where the home is able to improve the management have been proactive in identifying these (such as increasing staffing and looking at how care records monitoring can be improved) and have told us about these matters in the information we received prior to, or during our visits to the home. We noted that a innovative development the home has participated in was a review of care home residents by health services for dementia care. This concluded (as we saw in the report) that mental health crises for people living at Lightmoor View have been minimized, resulting in fewer admissions to hospital and as a result had a better quality of life staying in their home environment (this outcome based on the reviews feedback received from carers and relatives). We also saw that the management provide regular and robust supervision to staff to enable them to reflect on their practice and look at how they could improve this, Care Homes for Older People Page 28 of 32 Evidence: through such as appropriate training. We saw the home maintains records to help ensure that the health and safety of people living at the home is maintained, with such as complaints, accidents and incidents closely monitored to identify any trends and need for corrective actions. We sampled some of the homes risk assessments in respect of safe working practices and found that these are detailed and identify how the home can minimize risks to promote peoples safety. We saw evidence of audits that check on the systems in use at the home in respect of for example equipment and medication practice (the latter very robust including checks on the system and staff practice) that ensure any undue risks can be identified and minimized. Care Homes for Older People Page 29 of 32 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 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 3 To introduce an assessment checklist to act as a reminder for staff when carrying out admissions, this to ensure all pre admission tasks are completed and all an individuals prefrences are captured. To better document the individual activities and stimulation that people living at the home are involved with outside of group activities, this to assist in evidencing the social aspects of care plans are followed through. 2 12 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. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!