Care Home: Lovat House

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What the care home does well The people who live at Lovat house receive relevant information about the home, their needs are usually appropriately assessed and they only admit people whose needs they believe they can meet. The people who live at Lovat House generally enjoy the lifestyle at the home but there is scope to increase the number and range of activities. They enjoy the meals provided. They know how to make a complaint and are safeguarded from abuse. The home provides a comfortable, clean and homely environment and the people there benefit from being supported by well qualified staff who have been appropriately recruited. What has improved since the last inspection? A requirement was made at the previous inspection regarding fire doors being wedged open. We did not observe any fire doors wedged open during this site visit. What the care home could do better: The personal and health care needs of the people who live at Lovat House are usually met. Service users would benefit from having more detailed care plans and staff must ensure they always respect the privacy and dignity of the people who live there. A requirement has been made relating to this. There are some gaps in training, for example all staff need to complete infection control training. People who live at Lovat House generally benefit from a home where the care is well managed. However, there have been some shortfalls in management of records relating to incidents which may affect the wellbeing of individuals. For example, reports which the home should send to us about incidents that happen in the home have not been sent. A requirement has been made relating to this. The manager is addressing this. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lovat House 6 Crescent Road Wokingham Berkshire RG40 2DB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Amanda Longman     Date: 0 3 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 23 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 23 Information about the care home Name of care home: Address: Lovat House 6 Crescent Road Wokingham Berkshire RG40 2DB 01189786750 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Mr Ian Tappin,Mrs G Tappin The registered provider is responsible for running the service care home 26 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 26 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender; Either whose primary car needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Lovat House is a twenty-six bedded home providing residential care to older people. This is a long-standing home, operating in a converted Edwardian detached house, with later extensions, in a residential street in Wokingham. The home is close Care Homes for Older People Page 4 of 23 Over 65 26 0 Brief description of the care home to local amenities. Residents are accommodated on three floors served by a passenger lift. The building has been extended and improved over recent years. Additional ensuite bedrooms have been provided, together with the provision of en-suite toilets to some existing bedrooms; and improvements made to kitchen, laundry, bathrooms, toilets, dining and lounge space, as well as to the general internal layout and environment. The rear garden has been attractively landscaped to provide full accessibility with level paths, raised beds, sunny and shady areas and plenty of seating. The side and front gardens have also been landscaped. The home is confident it is able to meet a range of diverse needs. The current fees range from 409.50 pounds to 665 pounds per week. Care Homes for Older People Page 5 of 23 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of Lovat House was an unannounced key inspection. It was a thorough look at how well the service is doing. It took account of information received from the manager prior to our site visit, which was undertaken by Amanda Longman, regulatory inspector, on 3 April 2009. During the site visit we (the Commission) toured the home, observed care practices, spoke with people living at Lovat House, with visitors, with the manager and with some members of staff. We also examined a selection of care records and staff records. The last inspection for this service was completed on 11 April 2007. Care Homes for Older People Page 6 of 23 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 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 Older People Page 7 of 23 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 8 of 23 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive relevant information about Lovat House, their needs are appropriately assessed and they only admit people whose needs they believe they can meet. Evidence: The home has an up to date Statement of Purpose and Service User Guide. The information in the service user guide is presented in the form of a Residents and Relatives Information Book with laminated pages. People who are interested in moving in to the home are supplied with this information and are encouraged to visit the home before they decide whether or not it is right for them. We looked at the assessments for the two most recent admissions to the home. They were detailed about the care needs and personal information. The information we received from the manager prior to our site visit stated that if people were unable to visit the home she would visit them to undertake an assessment. Care Homes for Older People Page 9 of 23 Evidence: In their most recent quality assurance survey, in 2008, almost 78 of the people who took part said that they had confidence that Lovat House would take care of them. The remainder said they had confidence most of the time. The people we spoke with during our site visit confirmed that Lovat House was able to meet their needs. Some had visited the home prior to moving in and in some cases, their family had visited. Care Homes for Older People Page 10 of 23 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 personal and health care needs of the people who live at Lovat House are usually met. Service users would benefit from having more detailed care plans. Staff do not always respect the privacy and dignity of the people who live there. Evidence: The records we looked at showed that people living at Lovat House had up to date care plans which are based on their individual needs. These included for example, mobility, self care, nutrition assessments and continence records where appropriate. However, in some instances not all information sections were fully completed. We discussed this with the manager, who will expand the amount of information recorded on care plans. Care plans included manual handling assessments and risk assessments for various activities such as walking and mobility. One of the people whose care plan we looked at had cot sides on her bed and a generic risk assessment for cot sides was in place. Records of health care needs and GP visits are also contained in the individual care plans. Lovat House has in place an appropriate medication procedure and it provides training Care Homes for Older People Page 11 of 23 Evidence: for those staff who administer medication. We observed the care assistant doing the medication round while we were there. The medication is stored appropriately and the administration procedures were correctly followed. The individual medication records have photographs of the resident on them. A Residents Charter is provided as part of the information pack which includes residents rights to independence, choice, respect, dignity and privacy. We observed the care practices at Lovat House and the manner of the interactions between staff and the people who live there. Staff were polite and courteous and this was confirmed by the people we spoke with. However, we did observe the toilet door being left ajar whilst a carer was assisting a person to transfer from the toilet back to their wheelchair. The manager also witnessed this and explained there was not sufficient room in the toilet to allow the transfer to take place with the toilet door closed. The home will address this issue to ensure full respect of privacy is maintained. Residents may have keys to their rooms if they wish and all residents are on the electoral register. Care Homes for Older People Page 12 of 23 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 people who live at Lovat House generally enjoy the lifestyle at the home but there is scope to increase the number and range of activities. They enjoy the meals provided. Evidence: In the information supplied by the manager prior to our site visit it was stated that people can please themselves about what time they get up and go to bed and how they spend their time. We spoke with several people living at Lovat House who confirmed this. Lovat House offers a variety of activities and entertainments. The entertainments on offer for April were displayed in the home. There were six occasions advertised, including Music for Health, Rah Rah Theatre and Motivation Class. Records are kept of who attends group activities and whether or not they enjoy them. The motivation class starts with a quiz. There is an activities co-ordinator in post three and a half days each week who organises such things as arts and crafts. For example there was photographs of people wearing the Easter bonnets they had made. However, in the survey undertaken by Lovat House in 2008 the only question relating Care Homes for Older People Page 13 of 23 Evidence: to activities was whether people liked the musical entertainment provided. 44 of the respondents said they liked the musical entertainment all of the time and approximately 40 said most of the time, 22 said sometimes. On the afternoon of our visit some people were watching the television in the lounge, some people were in there own rooms, two people had relatives visiting and there was a Duke of Edinburgh student visiting who was chatting to some of the residents. The people we spoke with confirmed that visitors are always welcomed in to the home. We spoke in detail with one of the people who chooses to spend most of their time in their own room. They explained they were very comfortable and were very well supported by the staff but preferred to read in their own room. The room was comfortable and personalised. The home offers an ecumenical church service once a month and arrangements have also been made for one person to receive weekly communion. At present this appears to meet the religious needs of the people who live at Lovat House. There is a four week menu cycle. Lunch is a hot meal, with a pudding and an alternative is offered if people do not like what is on offer or if people have forgotten what they ordered and would like something else. Tea is a smaller cooked meal or sandwiches. We ate tea with the residents on the day of the site visit. The food was freshly prepared. Staff were seen to accommodate individual needs or choices. We spoke with the people we ate with who said the food offered at Lovat House is good. The dining room is domestic in style with small tables for up to four people. It is pleasantly furnished and equipped. The home received four stars in its most recent inspection by the Environmental Health Department and is currently following the guidelines contained in Safer Food, Better Business. Care Homes for Older People Page 14 of 23 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 who live at the home know how to make a complaint and are safeguarded from abuse. Evidence: The home has a complaints procedure which is contained in the Information Pack provided to residents and their relatives. We had not received any information about any complaints prior to our inspection. We looked at the complaints and compliments book during our site visit. It contained very detailed information about an their ongoing care of one resident which has been subject to complaints by the family. The records showed how they have dealt with these complaints and included their discussions with family members and their referrals to health professioals including the CPN and the psychiatrist. These detailed records should be stored on the service users file. The records also showed many examples of compliment letters about the care that people had received. The home has a procedure for dealing with safeguarding vulnerable adults. The manager informed us she is currently in the process of reviewing this procedure. Records showed that all of the staff had received training in the safeguarding of vulnerable adults in June 2008. Care Homes for Older People Page 15 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Lovat House enjoy a comfortable, clean and homely environment. All staff need to complete infection control training. Evidence: We toured the home during our site visit. It was very clean, homely and comfortable. Individual bedrooms are well furnished and personalised. The communal areas consist of a large, comfortably furnished lounge and a comfortably furnished dining room. The people we spoke with all said the home was always clean and comfortable. Evidence from the information provided prior to our site visit showed that gas, electrical and other equipment is regularly serviced in line with the manufacturers recommendations. The home has infection control procedures in place and provides training in this area. At the time of our site visit 20 of staff had not received infection control training. Care Homes for Older People Page 16 of 23 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 who live at Lovat House benefit from being supported by well qualified staff who have been appropriately recruited. There are some small gaps in training which are being addressed. Evidence: The home has a full compliment of staff which includes a cook and two housekeepers. There are four care assistants on duty everyday from 8:00am until 2:00pm and three on duty till 8:00pm. From 8:00pm until 8:00am there are two waking night staff on duty. The people we spoke with said that there were generally sufficient staff on duty to meet their needs whilst acknowledging that occasionally one had to wait if staff were busy seeing to another person. The home has a suitable recruitment procedure in place. No new staff have been recruited since the previous inspection so there were no recruitment records for us to view. Agency staff are not used. We viewed a selection of staff files. Supervision and training records are kept for each staff member. We saw from the training records that mandatory training was up to date for most staff. One person had not received manual handling training and there were some gaps in infection control training. Everyone had up to date training in fire safety and abuse prevention. The manager is making arrangements to address these Care Homes for Older People Page 17 of 23 Evidence: gaps. Additional courses included continence, nutrition and death and dying. Annual appraisals are undertaken in August each year. The manager and deputy manager are qualified NVQ assessors. 73 of the staff are qualified to NVQ level 2 or above. The people we talked with in the home, both residents and visitors, spoke highly of the staff and confirmed that they were polite and courteous and competent in their roles. Care Homes for Older People Page 18 of 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Lovat House generally benefit from a home where the care is well managed. There have been some shortfalls in the management of records, including relating to incidents which may affect the wellbeing of individuals. We have judged that overall the home continues to provide good outcomes for the people who live there. Evidence: Lovat House is a privately owned care home. The manager has been inplace for several years, is registered with us and is appropriately qualified. The people we spoke with on the day of our site visit spoke highly of the manager. The home has a stable staff team and there has been no turn over of staff since the previous inspection. The home undertakes an annual quality assurance survey for residents and staff. We saw the results of the survey for 2008. Eighteen out of nineteen residents who responded rated the overall performance of the home as very good or excellent. A copy of the results from this survey are contained in the Service Users Guide for Care Homes for Older People Page 19 of 23 Evidence: people to see. The manager told us that if any negative responses are received to the annual questionnaire this is always followed up. There was only one negative response from the last survey. Inviduals are invoiced according to their agreed payment terms and conditions and any incidentals are invoiced at the same time. These incidentals may include, for example, newspapers, chiropody visits, hairdressing and incontinence pads. Some records we looked at during the course of our inspection were not detailed. For example lack of detail on care plans is referred to in outcome area two above, and a lack of detailed records on the service user file for an on-going complaint (see outcome area four above). Furthermore the home has not notified us, under regulation 37 of the Care Standards Act of any serious falls or injuries or other instances which may affect the safety or well being of a person living at the home. We discussed these with the manager. The home has a record of providing good outcomes for servicice users, as illustrated by their previous inspection and their most recent quality assurance survey. The manager knows what further improvements need to be made and she will adress these. The home has a health and safety policy which was reviewed in March 2008 and the records showed that all but two of the staff had received training in general health and safety and the remaining two had received training in the course of their NVQ studies. All staff ahd received fire safety training and all but one of the staff had received manual handling training. Evidence from the information provided prior to our site visit showed that gas, electrical and other equipment is regularly serviced in line with the manufacturers recommendations. The home does maintain a record of accidents and incidents, however these are not always cross referenced to the service users personal file. Care Homes for Older People Page 20 of 23 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 21 of 23 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 1 10 12 The privacy of people using the downstairs toilet must be ensured. To ensure the privacy and dignity of service users is respected at all times. 06/06/2009 2 37 37 Reports required under regulation 37 of The Care Standards Act must be sent to CQC. To ensure the safety and well being of of the people who live at Lovat House 20/06/2009 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 22 of 23 Helpline: Telephone: 03000 616161 or Textphone: 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) Commission for Social Care Inspection (CSCI). 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. 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