Care Home: Loxley Chase

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What the care home does well The home continues to provide good systems and practices for caring for those accommodated. Recording systems were good and people had detailed admission assessments and care plans to reflect how their needs should be met. All of the people living at Loxley Chase said that they were well cared for. There are good opportunities for people to take part in social and leisure activities and opportunities for people to go out. Visitors are made welcome to the home and there were good relations between staff and people living at and visiting the home. Food was said to be of good quality and people were offered a choice. The home has clear policies and procedures for managing any complaints or allegations. Staff receive regular training to support them in carrying out their roles effectively. Management systems are good and staff say that they feel well supported. Records to ensure the health safety and well being of those living at or visiting the home were up to date. What has improved since the last inspection? A major refurbishment programme has been carried out throughout the home. This has included en-suite facilities to all bedrooms, new dining and lounge areas a new activities room and kitchen, sluice facilities on each floor and a new lift. The refurbishment has been carried out to a high specification and new furniture, furnishings and decoration have been provided throughout the home. All rooms are now single occupancy. The owners ensure that Regulation 26 reports are now provided on a monthly basis. These report on the standard and quality of care being provided at the care home. The manager has achieved an NVQ qualification at level 4 in management. What the care home could do better: Medication systems need to be improved upon and accurate records of any medication booked into the home must be available. Regular audits should be carried out and two staff should sign any handwritten entries on drug record sheets (MAR) to confirm that they are correct. The temperature of the drug treatment room should be monitored to ensure that medication is stored at a safe temperature. Consideration should be given to a `loop system` to support people who may have difficulties hearing. Key inspection report Care homes for older people Name: Address: Loxley Chase 3a & 5 The Crescent Linthorpe Middlesbrough TS5 6SD     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: Tanya Newton     Date: 2 0 0 8 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 22 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 22 Information about the care home Name of care home: Address: Loxley Chase 3a & 5 The Crescent Linthorpe Middlesbrough TS5 6SD 01642818921 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr George Dixon,Mrs Susan Olive Ellis,Mrs Angela Catherine Allick,Mr Michael Dixon care home 19 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 who can be accommodated is: 19 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 care needs on admission to the home are within the following category: Old age, not falling within any other category, Code OP, maximum number of places 19 Date of last inspection Brief description of the care home Loxley Chase is a care home providing personal care for older people. It is a threestorey building providing single en-suite accommodation for 19 residents. There is a newly installed shaft lift giving access to all floors. The home has a large lounge a day room/conservatory and separate dining room on the ground floor together with another room used for activities/treatments and social events. The home has been recently refurbished and the owners will be applying to increase the number of beds registered from 19 to 30. Loxley Chase is situated close to local Care Homes for Older People Page 4 of 22 Over 65 19 0 Brief description of the care home shops and amenities. There is a bus service which provides access to Middlesbrough town centre. There is car parking at the rear of the home. Please contact the provider directly for up to date information on fees. Care Homes for Older People Page 5 of 22 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: The inspection was unannounced and carried out over 5.5 hours. Prior to the inspection we looked at information provided in the homes annual quality assurance assessment (AQAA) which provides information about the service as well as some statistical information. We also received some surveys from people living at the home, from staff and from health professionals. Information from these has been included within the body of the report. During the inspection time was spent talking to the owners, the manager and to staff and a number of records were looked at. These included care files which are written for every individual accommodated, medication records, staff recruitment and training files, health and safety records, accident records and quality assurance records. Time was also spent talking to individuals who lived at or were visiting the home. Care Homes for Older People Page 6 of 22 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. 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 22 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 22 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. Peoples needs were assessed before moving into the home and they are assured those needs would be met Evidence: Three assessments were viewed. People who had been funded by the local authority had assessments which had been carried out by a care manager, these were then shared with the home. The manager then carries out a further assessment to determine whether or not the home is able to meet the persons individual needs. Comments from people include, I like it here, I had a look round before I moved in and I am here on respite, I visited the home first, to see what it was like. Four surveys were received from people living at the home and all confirmed that they had been given sufficient information to help them decide that the home would be suitable and that they had received a copy of the terms and conditions of residence. Two health professional surveys confirmed that assessments were always carried out appropriately. Care Homes for Older People Page 9 of 22 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. Peoples health and personal care needs were well recorded within their care plan and they were treated with dignity and respect. Medication systems need to be improved upon. Evidence: Care plans were looked at. Care plans set out the way in which peoples individual health and personal care needs will be met by staff working at the home. Care plans were reviewed regularly to reflect any changes in need. Care plans included risk assessments to minimize risks to people living at the home. Comments from people include, I have read my care plan, I am well cared for here and there is always a smiling face to greet you, the standard of care is very good, we are so well looked after. There was clear evidence in care plans that peoples health need were being closely monitored with input being sought from other professionals where this was required. This included district nurses, occupational therapists, dietitians, G.Ps and chiropodists. Care Homes for Older People Page 10 of 22 Evidence: Medication systems were looked at. The temperature of the drug treatment room needs to be monitored and a fan fitted if necessary to ensure that medication is stored at the correct temperature. During a check on medication, 200mls of oramorph liquid was found which was unaccounted for in the controlled drugs register. Contact with the pharmacist confirmed that this had been prescribed for an individual but it had not been recorded appropriately, once received by the home. The home must ensure that all medicines are appropriately recorded and that adequate stock checks are made. Any handwritten entries on mar sheets should be signed by two staff to confirm that they are correct. One person said, they help you with your medication and support you to attend hospital visits. Staff were observed throughout the inspection to be respectful to people, they always knock on bedroom doors before entering the room and people are spoken to politely. The relationship between staff and people living at the home was very relaxed. Comments from people include, the staff are very respectful, they knock on your door and its up to me when I get up and go to bed. Care Homes for Older People Page 11 of 22 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. Peoples social, leisure and recreational needs are met by the home. Food is said to be enjoyable and nutritiously balanced. Evidence: The home carried out a detailed NAPA assessment, which is a detailed activities of daily living file for each individual. This provided the activity co-ordinator with very detailed person centered information about each individual. The home then records all activities reviewing what people want regularly. Activities have included, dominos, nails, shopping, knitting, games, singers, baking and theatre trips as well as time spent talking to people on a one to one basis. The activity co-ordinator said that it would be good if the homes had a minibus to share between the group. All surveys confirmed that the food and the activities were good. Comments from people include, there are lots of activities, things like bingo, scrabble and dominos. We also have a motivation class which I enjoy and you can join in activities or entertain yourself, there is less going on at the moment but that is due to the refurbishment. The refurbishment includes a new activities room for people to take part in a variety of activities. Visiting arrangements at the home were said to be good, one of the visitors said, I Care Homes for Older People Page 12 of 22 Evidence: am always made welcome, there is always a smiling face to greet you and you can visit at any time. Another visitor was asked if they would like to stay for their lunch. The homes menus were looked at. There is a variety of food offered and people are always given a choice. Menus are displayed and people are asked what they would like. Fresh fruit and snacks are always available. Comments from people include, the food is fair, I am diabetic so that restricts what I can eat, the food is nice and we always get a choice and I am on a liquid diet, they make me things that I like. On the day of the inspection the main meal was a roast chicken dinner with potatoes and vegetables. It was nicely presented and tasty. Care Homes for Older People Page 13 of 22 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. Any concerns or complaints are managed well by the home with policies, procedures and training in place to support staff. Evidence: The home has a satisfactory complaints procedure. People spoken to during the inspection said that they had no concerns or complaints but felt confident in raising any issues as they arose.There have been no complaints since the last inspection. One person said, I have no concerns, if I had I would speak to my key worker, we can attend resident meetings too. The home has procedures for protecting people from abuse. Staff have received training in safeguarding vulnerable adults . Staff spoken with during the inspection said they knew what procedure needed to be followed if an allegation was made. They also confirmed that they would not hesitate to whistle blow (tell someone) if they saw or heard anything inappropriate. Care Homes for Older People Page 14 of 22 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has been updated to a high standard throughout. It is clean and odour free. Evidence: A major refurbishment has been taking place at the home. This includes en-suite facilities in all bedrooms, a new activities room, new day lounge, large extended dining room, new staff room, new office, 3 sluice facilities, new bathrooms and shower rooms. All bedrooms are individually furnished and decorated to a high standard with large flat screen TVs in all rooms which also have the option for internet access. Phone points are available in every room. All of the furniture in bedrooms is new and new tables and chairs have been purchased for dining areas and lounges. The home has a new lift to all floors and a new kitchen. All en-suite bathrooms are fitted with grab rails. CCTV has been fitted outside of the home and additional parking is going to be available. All rooms have a locked facility and although there are no locks on bedroom doors, the owners said that any person who wants one can have a lock fitted. The home should also consider providing a loop system to enable people with hearing difficulties to use their TVs. Care Homes for Older People Page 15 of 22 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. Peoples needs were met by the number and skill mix of staff who were trained and competent to care for people living at the home. People were protected by the homes recruitment procedures. Evidence: On the day of the inspection, there were three staff on duty for the eleven people who were living at the home. The AQAA states that the usual staff ratio is one staff to five residents. As the number of people living at the home increase the numbers of staff will be increased accordingly. Comments about the staff include, the staff are all alright, very good in fact, we will need more when the home fills up , I like the staff here and I cant say what I like best, the staff treat you as a whole person, they treat me with dignity and respect. Staff recruitment files were looked at, all contained an application form, two references and a police check. This information helps to protect people. Staff training records were also viewed, there are a variety of training courses available. Comments from staff include, we receive excellent training which allows us to provide a high level of care to residents and the home has a low staff turnover, many staff have been here for between fifteen and twenty years. It has an excellent training schedule for staff to participate in. Eight of the eleven staff currently employed have Care Homes for Older People Page 16 of 22 Evidence: gained an NVQ at level 2 or above. Care Homes for Older People Page 17 of 22 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. The home is well managed and run in the interests of service users. Health and safety systems protect those living and working at the home. Evidence: The manager had many years of running a care home for older people. Since the last inspection she has successfully completed the level 4 NVQ in management. Quality assurance systems were viewed. Surveys are sent out to residents and/or their relatives. The home devised a graph showing the results of the survey and developed a plan that took account of comments made in surveys. Surveys were last sent out in July 2008 and the manager said that they were due to send these out again. The provider visits the home on a regular basis, they also prepare a monthly report on the conduct of the care home. These reports were looked at during the inspection. The manager carries out regular in house audits. Meetings are held for staff and for residents. Care Homes for Older People Page 18 of 22 Evidence: Policy files are also being updated. The policy for holding peoples individual money was viewed and an audit carried out on two of the records held. Accurate records were being maintained. There is an annual plan of maintenance for the home. Records viewed were up to date. As the home is undergoing a major refurbishment a new emergency call system and fire system have been fitted. Weekly checks are carried out on the emergency lighting, water temperatures and bed rails. There is also a general risk assessment file which includes the management of risks to individuals living at the home and general ones for the environment. Fire alarm tests are carried out weekly. Care Homes for Older People Page 19 of 22 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 20 of 22 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 9 13 The home must ensure that 30/09/2009 all medicines are appropriately recorded and that adequate stock checks are made. Any handwritten entries on mar sheets should be signed by two staff to confirm that they are correct. To ensure that medication systems are safe and that there is a clear audit trail of any medication entering and leaving the home. 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 9 The temperature of the drug treatment room needs to be monitored and a fan fitted if necessary to ensure that medication is stored at the correct temperature. A loop system should be considered to support those with hearing impairments to access the televisions in their room. 2 19 Care Homes for Older People Page 21 of 22 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 22 of 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!