Care Home: Loreto Cottage Care Home

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What the care home does well Care planning is clear and staff know how to meet people`s needs.People told us they enjoy lots of different activities with staff and other people who live at the home. They enjoyed their holidays.People receive personal and health care in the way they want and need.People like all their meals at the home. They choose what they want to eat and told us they "Like sandwiches pack up" and "Like dinners".There is an appropriate Complaints Procedure and people feel safe.The rooms are clean and well furnished.The staff in the home are friendly and meet each person`s needs well.Staff are trained to support people in the right way What has improved since the last inspection? Some rooms have been changed and improved to meet people`s needs.Staff have introduced new Health Action Records for people to use themselves.Building work has meant that a new medication cupboard has been made available.New staff have started work at the home. What the care home could do better: They should provide a report for people so that they know what action is taken in response to comments made in their own questionnaires.They should reorganise staff files to show clearly that all required records are kept for each member of staff. Key inspection report Care homes for adults (18-65 years) Name: Address: Loreto Cottage Care Home Mapperley Plains Nottingham NG3 5RT The quality rating for this care home is: two star good 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: Meryl Bailey Date: 0 6 1 0 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 Adults (18-65 years) Page 2 of 29 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Loreto Cottage Care Home Mapperley Plains Nottingham NG3 5RT 01159269357 F/P01159267325 m1orla@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Margaret Dobbin & Mr James Dobbin,Mr Seamus Connolly Dobbin,Miss Sinead Dobbin care home 16 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 16 0 learning disability Additional conditions: Service users shall be within category LD Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 29 A bit about the care home Loreto Cottage has been converted and extended. A pub and shops are not far away. There are large gardens. There is a minibus to take people to different places. Everyone has their own room. Some rooms are on the ground floor, but others are up stairs. There is no lift. Care Homes for Adults (18-65 years) Page 5 of 29 It costs at least £307 each week to live there. Care Homes for Adults (18-65 years) Page 6 of 29 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 29 How we did our inspection: This is what the inspector did when they were at the care home The inspector talked to the people who live at the home. Everyone seemed happy there and said, I like staff and I like living at Loreto Cottage. Some people completed survey forms and sent them to the inspector after the visit. These helped us to understand what it is like at Loreto Cottage. Care Homes for Adults (18-65 years) Page 8 of 29 The inspector looked at documents that have to be kept. She looked at: Care plans. Staff files. Medicine records. The inspector looked around the home. This was to make sure it was safe and comfortable. What the care home does well Care planning is clear and staff know how to meet peoples needs. Care Homes for Adults (18-65 years) Page 9 of 29 People told us they enjoy lots of different activities with staff and other people who live at the home. They enjoyed their holidays. People receive personal and health care in the way they want and need. People like all their meals at the home. They choose what they want to eat and told us they Like sandwiches pack up and Like dinners. Care Homes for Adults (18-65 years) Page 10 of 29 There is an appropriate Complaints Procedure and people feel safe. The rooms are clean and well furnished. The staff in the home are friendly and meet each persons needs well. Staff are trained to support people in the right way Care Homes for Adults (18-65 years) Page 11 of 29 What has got better from the last inspection Some rooms have been changed and improved to meet peoples needs. Staff have introduced new Health Action Records for people to use themselves. Building work has meant that a new medication cupboard has been made available. Care Homes for Adults (18-65 years) Page 12 of 29 New staff have started work at the home. What the care home could do better They should provide a report for people so that they know what action is taken in response to comments made in their own questionnaires. They should reorganise staff files to show clearly that all required records are kept for each member of staff. Care Homes for Adults (18-65 years) Page 13 of 29 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Meryl Bailey Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA Tel: 03000 616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 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 Adults (18-65 years) Page 14 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 15 of 29 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. The assessment procedure ensures the needs of people admitted can be appropriately met at the home. Evidence: The manager described the process for new people moving to the home. This involved a series of visits including an overnight stay and meeting other people that live there. New people would only be offered a place if everyone was happy with the move. We saw preadmission assessments and more up to date assessments of needs in the case files. Care Homes for Adults (18-65 years) Page 16 of 29 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 the home are involved in planning their support to meet their personal needs and they are supported to be as independent as possible. Evidence: We looked at a sample of care files and found detailed action plans for staff to follow to meet peoples care and support needs. The plans covered the activities of daily living and were personalised, reflecting individual needs, choices, likes and dislikes. Care planning included risk assessments and the manager said they were looking at new ways to improve the way risks are assessed. It was clear people had been consulted and they had signed their own review forms. The staff on duty described peoples individual needs and support needed as in the care plan files. One new member of staff was working alongside other staff and developing an understanding of individuals needs. Care Homes for Adults (18-65 years) Page 17 of 29 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 at the home experience positive lifestyles and are enabled to take part in a range of activities. Individual choice is encouraged. Evidence: Most people were out attending various day services at the start of the inspection visit. They returned at various times. They told us about the different day centres and they enjoyed lots of different activities arranged by staff at the home too. On the previous Sunday they had all enjoyed a celebration meal at a hotel. A birthday party was commencing at the end of the inspection visit and a relative attended. One person was playing his electric guitar in the lounge. People told us about going to the pub on Friday nights and about holidays. They said The girls went to Blackpool and the boys went to Centre Parcs. They had thoroughly enjoyed these holidays. They also told us about going to Goose Fair. There was an activity record to confirm the activities that had taken place. Some people told us about swimming and going to a gym. An aromatherapist visited on one evening each week and Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: some people told us they enjoy hand massages. One person told us about regular literacy classes in the evenings as well as college during the day. In survey forms returned to us there was more information about activities. One person enjoyed painting and another liked doing some cooking and washing the pots. One of the staff said they need to plan different trips at the weekends and one person said Id like to do some walking. Anyone who had a birthday chose the type of food to have for the party and the person chose Fish and Chips. We observed staff asking each person individually what they would like from the fish and chip shop. There was a menu plan and a record of all meals eaten. Some people told us they talked about the menu in meetings. A packed lunch was provided as needed. People told us they Like sandwiches pack up and Like dinners. Care Homes for Adults (18-65 years) Page 19 of 29 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive their personal and health care and support in they way they prefer and need. Medication is well managed. Evidence: Preferences about individual support needed with personal care was given in the action plans. Staff told us that some people needed help with all their personal care, but most were fairly independent. One person said I wash myself, but staff sometimes remind me and I know they will help if I ask them. In the record of the last residents meeting we saw that staff had introduced the use of Health Action Records and people had commenced completing these. There were records on files of visits to health professionals. On the day of this inspection visit one person was supported to go to the dentist and also collected new glasses from the optician. Two people had recently been provided with new wheelchairs and one had a new walking aid. We found the medication had recently been moved to a temporary cupboard, but there were appropriate security locks. This move was due to some building work due to start the following day. After this inspection visit, one of the providers sent us confirmation that, although building work was delayed it had gone ahead and the new medication cupboard was available at the beginning of November 2009. The Medicine Administration Records were completed to ensure people received their prescribed medicine. Only senior Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: staff were involved in administering medicines and they had received training. One person managed prescribed cream with support and this clear in the assessment and care plan. Care Homes for Adults (18-65 years) Page 21 of 29 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. There is an appropriate Complaints Procedure and people are safeguarded from abuse. Evidence: The manager told us that each person and their relatives were informed of the complaints procedure on admission. We saw that the procedure was displayed on the wall. No one has contacted the Commission with any concerns about the home. People told us they were happy with everything at the home. Of the seven people who took part in our survey only one knew how to make a complaint, but they all knew who to speak to if they were not happy. This could be due to some people not understanding the concept of making complaints or not understanding the question. There were records of checks made on new staff to make sure they were suitable to work with vulnerable people and all existing staff had received training in Safeguarding Adults, the Mental Capacity Act and Deprivation of Liberty Safeguards. Care Homes for Adults (18-65 years) Page 22 of 29 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 live in a well-maintained and comfortable, homely environment. Evidence: A maintenance person was employed to carry out routine maintenance and a gardener maintained the extensive gardens to the side and rear of the property. People told us they liked the building. One person said quite nice and another said that they liked the way the staff cleaned the floors. We saw all the lounge and dining areas were homely and very clean. We saw some of the bedrooms and these were clean, decorated to individual preferences and with good quality furniture. The stairs are narrow and steep and not suitable to meet the needs of anyone with restricted mobility. The staff and manager told us of the planned building work to adapt some rooms to meet peoples changing needs and ensuite facilities were being included. We have since been informed that the building work has been completed. Further work was planned to refurbish older ensuite facilities for one person. Care Homes for Adults (18-65 years) Page 23 of 29 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 benefit from some skilled and experienced staff and appropriate new staff who are developing skills to meet needs. Evidence: There had been some recent staff changes and we saw two new staff including one that was working in addition to those on duty. The staffing records showed that checks had been made on staff before they started work. There were loose papers in folders and some older staffing records were not filed in order (see the management section of this report), but all relevant records appeared to be present. There were some records of supervision meetings and staff meetings were held in April, June and September 2009. The manager told us that these would be more regular now that new staff have been recruited. Training in the Common Induction Standards was planned for the new staff. Training records for other senior staff showed that in the last year they had completed training in Medication, Dementia Awareness, and the Mental Capacity Act. We saw a certificate to show that one person had attained a National Vocational Qualification (NVQ) at level 3 in Care in March 2009. The manager told us that six other staff had attained NVQ level 2 Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the interests of people living there. Evidence: The home is managed by one of the family that owns the home. The other members of the family are in daily contact and people living at the home knew them all well. One person said Ive known them for a long time and I know they will always look after me. Other people said, We get the very best, It’s a nice place. The family used questionnaires once a year, so that people could make comments about the quality of the service, but there was no report of the comments made or action taken. The manager sent in the completed Annual Quality Assurance Assessment when we asked for it. On this he told us that from listening to people in residents meetings they have adjusted the meals menu and arranged holidays that were requested. We saw records of these meetings that had been held most months. During this inspection we have found that action has been taken to meet previous requirements we have made. There were records of regular safety checks on water temperatures and fire equipment. The AQAA form gave us information about the servicing of equipment and systems and Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: these had all been carried out within the last 12 months. There were records to show that staff had been trained in assessing risks and in the safe working topics. Records were not all kept in an orderly fashion and some staffing records were not on the premises, but were brought in for us to see. The manager acknowledged the need to continue working on managing records and felt that he would have more time for this now that new staff had been recruited. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 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 Description 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 Description 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 39 Provide a report for people who have completed questionnaires so that they know what action is taken in response to comments made. Reorganise staffing records in order to demonstrate clearly that all required documents are kept for each member of staff. 2 41 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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