Care Home: Little Acre Care Home

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What the care home does well People living in the home and their relatives gave very positive feedback on the service and the care and support provided. During our visit we spoke to the daughter of one of the residents who was in the home at the time. She told us that she had visited several homes before deciding that Little Acre was the one most suitable to care for her mother. She also said that the family were delighted that they appear to have made the right choice. She told us that `the staff have a very caring attitude and are friendly and warm to both residents and visitors`. We observed that the relationship between the staff and residents was warm and supportive and we could tell that the staff knew the residents extremely well. Admissions to the home are only made after a thorough assessment of daily needs is completed to make sure Little Acre is best placed to meet those needs. Relevant and up to date care plans are in place, which are reviewed monthly to take into account any changes in the dependency levels. The manager is very involved with the care and support provided and she has a clear vision of what the home hopes to achieve. The environment is relaxed, friendly, clean and fresh with residents` rooms personalised with items brought from home. There is an annual repairs and maintenance programme to ensure that standards remain high. There are systems in place for handling medication to make sure peoples` medicines are managed safely and that all receive the correct treatment at the right time. Healthcare needs are met through good working relationships with the healthcare professionals. There is an experienced and qualified staff team with well over half the staff qualified to NVQ level 2 or above. The home has a comprehensive recruitment and selection policy that ensures only suitable people are employed to care for those who use this service. What has improved since the last inspection? Since the last inspection the admission assessment form has been improved to ensure more in-depth information is gathered before an offer of a placement is made. Care plans have become more person centred and this system will be further improved through the use of relationship maps/circles to identify what is most important to the residents. A digital photo frame has been purchased in order for residents to view pictures of activities inside and outside the home. Environmental standards continue to be high through an annual programme of maintenance and upkeep. . What the care home could do better: There were no requirements or recommendations made as a result of this inspection and we are confident that this home will continue to provide the standard of care and support already in place. Key inspection report Care homes for older people Name: Address: Little Acre Care Home 82 Skinburness Road Silloth Cumbria CA7 4QH     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: Margaret Drury     Date: 1 6 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) 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 26 Information about the care home Name of care home: Address: Little Acre Care Home 82 Skinburness Road Silloth Cumbria CA7 4QH 01697332105 01697331719 sarah@littleacrecarehome.co.uk www.littleacrecarehome.co.uk Little Acre Care Home Limited care home 14 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 old age, not falling within any other category Additional conditions: 0 14 The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Dementia - Code DE. The maximum number of service users who can be accommodated is: 14. Date of last inspection Brief description of the care home Little Acre is a care home providing accommodation, personal and social care for up to fourteen older people, six of whom may have varying forms of dementia. The home is owned by Little Acre Care Home Ltd and managed on a day-to-day basis by Mrs Sarah Betsworth. Little Acre is situated two miles from the centre of Silloth and has uninterrupted views over the Solway Firth. The home is single storey and has been extended and adapted for its present use as a care home. The accommodation for residents is on the ground floor, with fourteen single bedrooms, thirteen of which have en-suite toilet facilities. Care Homes for Older People Page 4 of 26 Brief description of the care home There is a large lounge and well appointed dining room, which give ample communal space for the residents to use. There is a bath, shower and toilet, all of which are suitable for people with a disability. The home has large, well-kept gardens and car parking at the front of the building. The fees at this home range from 398.00 to 462.00 per week as at the date of the inspection. There are extra charges for hairdressing, newspapers, magazines and private chiropody. This home does not provide intermediate care. 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: This site visit that forms part of a key inspection took place on the 16th of July and we (The Care Quality Commission) were in the home for just over 5 hours. Information about the home was gathered in a number of different ways and this formed the basis for this inspection. We received an Annual Quality Assurance Assessment (AQAA) from the manager within the timescale allowed. It is a legal requirement that this document is completed annually by all regulated services. The AQAA was comprehensive and outlined the facilities and services that the home offers. It gave information about any improvements made since the last inspection and what the manager hopes to achieve over the next 12 months. We sent out questionnaires to staff, residents and family members, spoke to staff residents and visitors on the day and looked at the results of the recently completed internal quality audit. All the information gathered helped to assess this service to make sure all assessed needs were being met. We looked at care planning documentation and copies of the original assessment of Care Homes for Older People Page 6 of 26 needs to ensure the support provided met the hopes and expectations of all those living in the home. We made a tour of the building to inspect the environmental standards, looked at staff records and examined all health and safety aspects of the service. 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: 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. Care Homes for Older People Page 8 of 26 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. There is a good system to introduce people to the home, with information provided and a care needs assessment completed. This ensures all who are admitted know their needs can be met in an appropriate way. Evidence: The home provides all prospective residents and their family with an information pack that gives plenty of information about the facilities on offer so they are able to make an informed choice about whether or not to move in. There is an up to date and relevant admissions procedure in place with improved documentation. This now includes details about personal preferences, likes and dislikes, medication and the kind of social activities the resident would enjoy. Assessments are completed by the manager or her deputy and cover all aspects of daily living, health and personal care. If the manager feels it appropriate or necessary she will invite family members to take part in the assessment. People wishing to use this service are invited to visit the home to look around and Care Homes for Older People Page 11 of 26 Evidence: meet the staff and others living in there. Many residents have enjoyed periods of respite care before moving in on a permanent basis. All residents have a written contract that includes a copy of the complaints procedure and outlines the terms of residency and their personal rights. The fees charged are in line with those laid down by Social Services with extra charges for hairdressing, chiropody and newspapers. The service does not provide intermediate care but there is provision for people who wish to stay for short periods of respite care. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home are now given the opportunity to be involved in the development of their individual care plan. This means they will receive the care and support they need in the way they prefer. Evidence: Every resident has an individual plan of care that is based on the initial assessment of needs and risk assessments. Since the last key inspection new documentation has been introduced to make The care plans more person centred and unique to the individual. The manager is currently working with a relationship circle tool to identify what is most important to each resident in order to ensure the most appropriate care and support is provided to best meet the individual needs. This will also involve the residents themselves and if necessary family members too. The information on the care plans covers all aspects of daily living, nutrition, healthcare and medication, communication, social and religious preferences. Healthcare needs are met through good working relationships with the local G.P. surgeries, district nurses and community psychiatric nurses. Chiropody, dental and optical services are available to all residents mostly via domiciliary visits unless the Care Homes for Older People Page 13 of 26 Evidence: resident wishes to go out. We looked at the records for the receipt, administration and disposal of medicines and found this to be in order. There are policies in place relating to medication and all the staff who administer medicines have been appropriately trained. The manager, who is a registered nurse, also completes in-house training with the care staff. She regularly administers medicines herself whilst conducting medication audits at the same time. The medication is received from the pharmacy in a monitored dose blister pack system and is checked in by the manager. There is also a system for the return of any unwanted or unused medication. There is currently no high risk medication prescribed but there is an appropriate recording system in place. We observed the way in which staff interacted with the residents and found this to be in a calm and relaxed manner. Residents we spoke to remarked on the kindness of the staff and how well they were looked after. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities and meals are both well managed and provide daily variation and interest for people living in this home. Evidence: The manager has looked at many ways of providing meaningful activities for those living in Little Acre. There is always a monthly programme pinned up in the hall so that residents can see at a glance what is planned for any given day. There is a variety to choose from , which includes, quizzes, poetry, baking, hand and nail care, visiting entertainers such as The Frantic Theatre Company and a magician. Outings using the community transport are also organised. As the transport has a tail lift anyone who may have mobility problems is able to enjoy the trips. The managers husband who is a partner in the business is able to drive the transport when they go out. The manager ensures she speaks to residents every day to make certain they are satisfied with the care they receive and to ask for new ideas for activities. A number of bird feeders have been purchased and placed in front of windows so the residents can watch the birds. Communion is available every 2 weeks for those who wish to take it. This also provides spiritual support for those living in the home. Families and friends are welcome to visit and are offered refreshment during their visit. We were able to speak to one of the visitors and she was very complementary about the home and the Care Homes for Older People Page 15 of 26 Evidence: staff. We were told that As soon as we came into the home we knew it would be right for mum. The staff are wonderful and mum now looks on Little Acre as home. There is a nutritious and varied menu provided with a choice at all mealtimes. Residents are able to choose where they wish to eat and some do stay in their room. We observed lunch being served and noted that there was a calm and peaceful atmosphere. Any resident who may need assistance was given help in an unobtrusive manner. All the residents we spoke to agreed that they enjoyed their food and the cook does come to chat to them at various times during the day. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good safeguarding procedures help to ensure that people remain safe in this home. The complaints procedure is clear and accessible meaning that people using this service know any concerns will be listened to and acted upon. Evidence: There are suitable policies and procedures in place for dealing with complaints and concerns. The complaints procedure forms part of the residents contract and there are copies on display around the home. The manager is available to speak to residents and their families if they have concerns. There have been no complaints to record in the log and we, CQC, have not received any. Neither have we received any concerns from other agencies. There are clear procedures in place for the protection of vulnerable adults and staff training in this subject is updated by the manager each year. Staff records show that all staff have enhanced Criminal Record Bureau checks that are in place before they start work. The home also has a copy of Cumbrias policy for staff reference if necessary. This subject is discussed during staff induction and supervision. There have been no adult protection referrals made. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Little Acre Care Home provides a safe and comfortable home that is well maintained, decorated and furnished to a high standard. Evidence: Little Acre is situated in a pleasant area of Silloth overlooking the Solway Firth with views to Scotland. Accommodation for the residents is all on the ground floor giving access to all. There are 14 single rooms with all but one (respite) having en-suite facilities. The home is extremely well maintained through an annual repairs and maintenance programme. The home has recently been extended to provide further bedrooms and an extension on the lounge has meant there are separate sitting and eating areas. The lounge has views overlooking the garden and Scotland and the dining room overlooks the garden. The residents rooms are bright, airy and well appointed and decorated. Residents have brought in personal items from home that has made them individual to each resident. At a recent meeting the residents requested that their rooms have their names on and this has been done. Some residents also asked for pictures to be put on with their names. The home has the necessary hoists and other aids to assist mobility and there are toilet aids and handrails available for those needing them. Sufficient communal bathing, shower and toilet facilities are available. The kitchen and food preparation area was very clean on the day of our visit as was Care Homes for Older People Page 18 of 26 Evidence: the rest of the home. Laundry facilities are situated well away from the food preparation and kitchen area. There is ample outside space for the residents to enjoy with secure gardens that are accessible to all those living in the home. The residents are being encouraged to help with tending the pots of flowers on display. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Little Acre are cared for by an experienced and trained staff team. This ensures all personal, social and healthcare needs are met in an appropriate manner. Evidence: Staffing levels are, overall, satisfactory for the number and dependency levels of those currently living in Little Acre. It is also helpful that the accommodation is all at ground floor level. We looked at the staff rotas and observation during our visit indicated that the home had sufficient staff on duty with the necessary skills and experience To provide a consistently high level of care and support. There are 2 members of care staff plus the manger on duty during the day with 2 waking night staff. The managers husband, who is joint owner is also present in the home on most days. There is also a full time cook. Staff files were examined and confirmed that the home has robust and effective recruitment procedures and follows good practice guidelines with regard to the recruitment and retention of staff. There is a low staff turnover, which provides consistent care for the residents. All staff have enhanced Criminal Records Bureau and Protection of Vulnerable Adults checks in place prior to starting work. Inspection of a sample of staff files showed that all the documentation required to meet the National Minimum Standards was in place. Well over 50 of the staff have completed National Vocational Qualification training in care at level 2 or above with other staff getting ready to complete the award. The Care Homes for Older People Page 20 of 26 Evidence: deputy manager has recently completed the registered manager award. Training is ongoing with the manager able and qualified to provide much of it in house. Courses completed include, manual handling, medication, dementia care and an external course on first aid is currently being organised. The manager and her deputy have recently completed training in The Mental Capacity Act and the Deprivation of Liberty. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Effective management and quality monitoring help safeguard people using this service and procedures are in place to safeguard their interests and promote their health and safety. Evidence: This service has an experienced and qualified manager, Sarah Betsworth, who has owned the home for a number of years. She is a qualified nurse and maintains her professional development and registration through relevant training. She works closely with the small staff team to ensure the home is run well and in the best interests of the residents and their families. The atmosphere in the home was warm and friendly and it was obvious that she knew all those living in the home extremely well. Comments from residents and family member confirmed this and included. Sarah was extremely helpful when mum was admitted and I can speak to Sarah at anytime. Staff who spoke to us also had positive comments about the management of the home and agreed that Little Acre was a lovely place to work in. The manager makes sure she is always available to answer any questions and staff Care Homes for Older People Page 22 of 26 Evidence: and residents all agreed that she is very approachable. Annual quality audit questionnaires are sent to residents, families and healthcare professionals and the manager was able to show us the results from the most recent audit. This showed that, according to those who were surveyed, Little Acre was providing a high standard of care. There is a procedure in place for handling residents finances although there are only small amounts of cash held on behalf of some of the residents. There is a full set of policies and procedures in place that are regularly audited to ensure they remain in line with current legislation. There is a fire risk assessment in place and Mr Betswoth is the recognised fire warden. He has just organised an update in his fire warden training. Records and servicing contracts indicated that the home arranges for all equipment to be serviced under annual service level agreements and all the necessary certificates were up to date and available for inspection. Staff are regularly supervised to ensure their professional development and that they are up to date with safe working practices. Records of this are kept on the individual staff files. Care Homes for Older People Page 23 of 26 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 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 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. 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. 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