Care Home: Loxley Court

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What the care home does well People who may wish to use the services of Loxley Court have the information they need to make an informed decision about the home. Some individuals are involved in decisions about their lives, and they are encouraged by the staff to have an active role in planning the care and support they receive. The home has policies to protect people from abuse and promote their rights. The physical design and layout of the home enables people who use the service to live in a safe and comfortable environment, which encourages independence. What has improved since the last inspection? The home was rated excellent during the last key inspection on 30/05/ 2006. Generally the management and the staff had tried to maintain the standards. However this time we have identified the following areas which need attention. What the care home could do better: Staff must be available at mealtimes to offer assistance in eating where necessary so that staff are able to offer assistance discreetly, sensitively and individually. Independent eating must be encouraged for as long as possible whilst there are staff available to supervise discreetly.So that people using the service are able to receive their nutrients. The service users must be given the opportunity to sit at the dining table using the dining chairs provided.So that people are able sit comfortably at the table and also relieve pressure areas by moving from the wheelchair to the dining chair. Staffing numbers must reflect the dependency levels of the people who live at Loxley Court. The manager must ensure sufficient number of staff are deployed during peak times. So that the people who live at the home are able receive the correct levels of care and supervision. Key inspection report Care homes for older people Name: Address: Loxley Court 455 Petre Street Grimesthorpe Sheffield South Yorkshire S4 8NB     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: User doesnt belongs to any group     Date: 1 9 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Loxley Court 455 Petre Street Grimesthorpe Sheffield South Yorkshire S4 8NB 01142420068 01142425899 loxleycourt@exemplarhc.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Loxley Health Care Limited care home 78 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The service may admit service users between the ages of 60-65 years. Date of last inspection Brief description of the care home Loxley Court provides a care service for 78 service users. The home is purpose built, and service users can easily access all areas within the home. There is a large car park to the front of the property and although the home is large, it has been divided into smaller living units. Bedrooms are situated over three floors and service users can access these by using the lift. 0 0 0 Over 65 48 10 20 Care Homes for Older People Page 4 of 26 Brief description of the care home The weekly fee ranged from 333 to 476 GBP on the day of our site visit. The home charges extra for chiropody, toiletries, clothing, telephone, holidays and hairdressing. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. An inspection of this care home was carried out on Tuesday 19th May 2009 between 9am and 5pm. The staff, the management, the people using the service or the visitors were not informed of our visit and therefore it was unexpected. Ten people who use the service and four visitors were consulted on the day. We also spoke with eight staff that were on duty. A further 15 people using the service, 10 staff Care Homes for Older People Page 6 of 26 and four professionals who came into contact with the people were contacted by post and telephone to obtain their views on the service. Comments received from the surveys have been included in the body of the report. Time was also spent observing and chatting with staff and the people using the service. The management, which included the registered manager and the operations manager were present most of the time. We informed them of our findings throughout the day, which helped both parties to verify and start taking action when it was needed. The premise was inspected, which included bedrooms of people using the service and communal areas. Private areas were accessed with the permission of the people and/or the staff at the home so that we respected the peoples wishes. Samples of records such as the care plans, staff supervision and training files were checked. We would like to thank the people who live at Loxley Court, their relatives, the staff who took part and the management for their contribution toward this process. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may wish to use the services of LoxleyCourt have the information they need to make an informed decision about the home. Evidence: A service user guide was available to people who visited the home, which outlined the objectives and the aims of the home as well as the facilities avaliable. One relative said, I was given a copy of the service user guide when I first visited the home by the senior nurse. We checked two service users Terms & Conditions. They were signed and dated by the people who represented the service users since the individuals did not have capacity. We checked four service user files and out of four we found copies of two needs assessments. We were informed by one of the unit managers that they had not received the remaining two assessments from the placing authorities on admission. But they had carried out the preliminary assessment before admission and have used Care Homes for Older People Page 10 of 26 Evidence: the information to formulate the care plans. Two care staff, three service users and one relative said that residents were given plenty of opportunities to review their stay at the home and that no one was at the home against their will. These were some comments we received. Care staff said, Some people take a long time settling in. Often they miss their home surroundings and at times get confused. Well time is a good healer. Once the residents get to know us and get used to the routines they settle in well. One of the service users said, This is the next best thing to being at home. My family live away from Sheffield and I have lived here all my life. I dont want to move. I have got everything I need here. One relative said, My W does not know where s/he is but seems comfortable and gets the care s/he needs. I visit most days and I know if s/he is not happy here. I am satisfied my W is in the right place. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is in the main based on their individual needs. The staff in general put into practice the principles of respect, dignity and privacy whilst working at the home. Some individuals are involved in decisions about their lives, and they are encouraged by the staff to have an active role in planning the care and support they receive. Evidence: Three service user files were checked and three staff were interviewed. We spoke with eight service users about their views on how the home provided their care. The care files were not comprehensive and there were several gaps in the records. For example the base line observations on admission had not been completed. A resident was receiving soft diet but there was no record of why this was the case. There were statements about aggressive behavior of service users but there was no reference to when or what factors were causing such behavior. In other words there was a lack of information and explanation in individuals care files. On each service user file a full body chart was kept with recording of sores, bruises or any marks. This is good Care Homes for Older People Page 12 of 26 Evidence: practice and proved invaluable evidence when investigating incidents. The care staff said that they had equipment to help with promoting tissue viability and infection control. We were informed that nurses administered medication and that none of the service users on the day of our site visit were able to self medicate. One care staff said, The nurses give out the medicines. If someone was slow taking the tablets the nurse stays with them and only sign the card once the resident had taken the medicine. The manager said that the supplying pharmacist carried out audits and the nurses took actions on any problem areas and made sure that they comply with the recommendations. These were some comments we received with regards to this outcome area. I am very happy with the staff. They help me when I ask for help. All the care staff are pleasant and helpful. The staff made the following comments. We address people in the way they prefer. Most of the residents wants us to call them by their first name. I knock on the door before I enter the rooms and close the curtains if I was to help with personal care. I have worked in the care sector for many years and I have looked after many people when they reach their end of life. Its all about keeping the person comfortable and the family informed. We were informed that the residents mail was distributed by the administrator or the unit managers and that if the resident asked the letters were read to them by the managers. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use services are on the whole able to make choices about their life style, and receive support to maintain their life skills. Social, cultural and recreational activities in general did not meet the individuals preferences, capacity and expectations. Evidence: We spoke with five service users, three staff, two relatives and the activities coordinator about the routines of daily living and social activities available to the people living at the home. They informed us that people had opportunities to have 1:1 or group activities. The group activities often took place in a designated room where a variety of activities such as games reminiscence therapy and crafts were available to residents. One resident said, I enjoy painting and when the activities person X goes on leave she sets me some painting to keep me busy. Another said that s/he did not want to participate in activities, but liked to just sit and chat with staff. The people had visitors and they were made welcome by staff at the home. We were informed that most of the service users were unable to handle their finances and therefore their family member helped them. The administrator kept some pocket Care Homes for Older People Page 14 of 26 Evidence: money for each service user so that they were able to buy and pay for personal items and hair dressing. The money transactions were supported with receipts and regular checks were carried out by the company auditor. During mealtimes we noted that staff checked on those who had problem with eating and offered them help. They also maintained records of food eaten by those at risk. Mealtime was not organised and this resulted in people waiting to be helped. Many of the service users ended up having food which was not warm. We observed service users brought to the dining room almost 45minutes before mealtime and left in wheel chairs at the tables waiting for the meals to arrive. The service users who were unable to walk safely were brought to the dining areas in wheelchairs by the staff. We noted that the service users were not offered a dining chair to sit on whilst they had their lunch. We appreciate that some of the people in wheel chairs were unsafe if they were to be seated on the dining chair however the others were not given the choice. We saw service users enjoy their meals and the staff offering them a further helping. It was confirmed during the conversation with staff and some relatives that the staffing levels at mealtime was not enough to ensure the service users received adequate help. Management were informed of our findings. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns to the management. The people have access to a complaints procedure, which is available at the entrance. The home has policies to protect people from abuse and promote their rights. Evidence: Three staff and two relatives and two service users were consulted with regards to this outcome area. The manager had a record of formal complaints received by the home with records of investigations and the findings. These were some comments we received. My father has been here for a long time and sometimes we get upset about some trivial incidents. There is always staff available to speak to us and help us put things right. I dont need to know any formal reporting, I talk to the staff and we sort any disputes before it gets out of hand. Often relatives feel upset to see their loved ones deteriorate especially people suffering dementia. I have had personal experience and I try and listen to peoples concerns and do my best to sort them out. I have found out its best not to confront people but to be tolerant. I make sure I inform the unit manager. We checked four staff training files and all four staff had attended training on Protection of Vulnerable Adults. The two staff we interviewed were able to verbalise the actions they would take if they witnessed abuse of service user or staff at the home. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe environment, which encourages independence. Evidence: We toured the home with the manager. The home was divided into 4 units depending on the needs of the people who live there. The present layout was suitable for the stated purpose. It was accessible, safe and met the needs of the people living at the home. The manager and the operations manager informed us that a program of maintenance was underway and that renewal of furniture and fabric was included in it. We witnessed some work being carried out in the dining area of a unit. The bedrooms we checked were centrally heated and naturally ventilated. These bedrooms looked safe and comfortable. Some were individualised with peoples own ornaments, photos and other personal items. Aids such as walking frames were made available to those people who needed them. Each unit had communal areas and these were well used by the people at the home. During our visit the home was clean and tidy. There were systems in place to control any spread of infection. Care Homes for Older People Page 17 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care staff in the main, are trained and skilled to carry out their jobs. The number of staff during each shift needs to be sufficient to support the people who use the service and promote the smooth running of the service. Evidence: We checked the staff rota and spoke with the residents and the staff on duty. We were informed that usually during the day there was sufficient number of staff however during peak times especially meal times there were insufficient numbers of staff to help people who needed assistance. The manager was informed of this.We checked four staff files and can confirm that the management operates a rigorous recruitment process based on equal opportunity and protection of people who live and work at the home. We received the following comments. The staff said, The company is very good at providing the training we need. There is always information about available training. The dependency levels of these residents have increased and we could do with more staff. Mealtimes are very difficult. We did try bringing in all the workers to help. This included domestics and others working at the home. It didnt work out because the domestics cleaned the communal areas whilst the people were having their dinner. I have completed NVQ2 and would like to do NVQ3. I am happy to wait my turn. Care Homes for Older People Page 18 of 26 Evidence: The relatives said, They could do with more staff. The care staff are always rushing around. They dont have time to chat with people. When staff dont turn up I dont think the manager gets additional staff to help. I see staff struggling because the people here need a lot of care and supervision. My concern is that the staff who are committed to doing a good days work get punished for those who dont turn up. The management explained that they take every effort to maintain staffing levels and sometimes it was difficult to find staff at short notice. Care Homes for Older People Page 19 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on respect . The validity of the quality assurance systems needs to be reviewed so that improvements are evaluated and staff roles and responsibilities are transparent and fit for the purpose of the home. Evidence: A new manager to the service has been appointed and the management were making arrangements for her registration. The senior staff at the home with the help of the responsible individual had carried out a variety of audits to measure the performance of the home. Results had been analysed and actions were in progress. The administrator of the home was responsible for the residents money. He too was new and he was reviewing the systems to improve the records. We checked four peoples moneys. Written records of all transactions were correct. We were informed that the unit staff kept receipts of possessions handed over for safe keeping. The management at the home promote the health and wellbeing of the people who live and work by promoting training and good practice guidance. Care Homes for Older People Page 20 of 26 Evidence: The following comments confirmed this. There is always room for improvement but the staff here are committed and give good care. I have not been able to attend some of the training due to personal circumstances. The unit manager is on the case I will be attending the training as soon as I can. I have not been able to look after my Father/ Mother at home. I looked at two more homes and chose this. I can say that s/he is kept clean and well fed. These staff have a lot to put up with and I have only praise for them. Can they have more staff Care Homes for Older People Page 21 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 14 The service user plan must 03/09/2009 set out details of the individuals needs and measures to be taken by the staff to meet those needs. The care plan reviews must give reasons for any changes in the persons needs and the action by the staff to accommodate the changes. So that all aspects of health, personal and social care needs of the people can be met. 2 14 12 Service users must be given the opportunity to sit at the dining table using the dining chairs provided. So that people are able sit comfortably at the table and also relieve pressure areas by moving from the wheelchair to the dining chair. 03/09/2009 Care Homes for Older People Page 23 of 26 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 3 14 12 Service users must not be left in the dining room waiting for meals without staff in attendance. So that peoples choices are respected. 03/09/2009 4 15 12 Staff must be available at mealtimes to offer assistance to residents. Independent eating must be encouraged for as long as possible whilst there are staff available to supervise the people. So that people using the service are able to receive nutrients and enjoy mealtimes. 03/09/2009 5 27 18 Staffing numbers must reflect the dependency levels of the people who live at Loxley Court. The manager must ensure sufficient numbers of staff are deployed during peak times. So that the people who live at the home are able receive the correct level of care and supervision. 03/09/2009 6 33 24 The management must review the quality of service provided by the home and ensure arrangements are in 03/09/2009 Care Homes for Older People Page 24 of 26 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 place to supervise and support staff. So that the staff are able to provide a good quality of care at all times. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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