Care Home: Lytchetts

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What the care home does well The home`s pre admission procedure is good and prospective residents and their representatives are provided with sufficient information about Lytchetts to enable them to make a decision about living there. Relatives and key people are actively encouraged to be involved in the life of the home and in the planning and meeting of residents` needs. Residents are treated with respect, their history and life style informing care practice. A balanced diet is provided and residents are supported to make choices and enjoy their meals. Lytchetts provides a comfortable, clean environment that ensures a home from home feel for people living there. Recruitment practices are good and ensure that all documentation required is in place, before staff members commence employment, ensuring that residents are in safe hands at all times. Health and safety management is good, ensuring that any risks to people are minimised. What has improved since the last inspection? This is the first key inspection for this home since it has been owned and registered with Consistent Care Ltd. What the care home could do better: This report contains one good practice recommendation that a staff training matrix is developed. Key inspection report Care homes for older people Name: Address: Lytchetts 4 Chalky Road Broadmayne Dorchester Dorset DT2 8PJ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Joanne Pasker     Date: 1 9 0 3 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 25 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 25 Information about the care home Name of care home: Address: Lytchetts 4 Chalky Road Broadmayne Dorchester Dorset DT2 8PJ 01305853524 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Consistent Care Limited Name of registered manager (if applicable) Mrs Sarah Gardiner Type of registration: Number of places registered: care home 15 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 15 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Lytchetts is registered with the Care Quality Commission to provide residential care for a total of 15 older people. The home is situated in Broadmayne, a small rural village close to Dorchester. There is parking space for visitors available at the front of the home. The building is on two Care Homes for Older People Page 4 of 25 Over 65 15 0 Brief description of the care home floors, with 12 bedrooms on the ground floor and 3 bedrooms on the first floor. There is a small comfortable lounge on the ground floor, which is also used as a dining area and meals are prepared on the premises. There are also attractive gardens for residents and visitors use. The home is owned by Consistent Care Ltd; the Registered Manager is Mrs Sarah Gardiner. It is also possible to view the homes website on www.lytchetts.co.uk and contact them by e mail on lytchetts@btconnect.com. Additionally, the fax number is 01305 854832. The fee prices in March 2009 range from £430 to £620 per week. See the following website for further guidance on fees and contracts: www.oft.gov.uk (Value for Money and Fair Terms in Contracts). Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This was a statutory unannounced inspection, required in accordance with the Care Standards Act 2000 and assessed the homes compliance with all key standards of the National Minimum Standards. It was also the first inspection since Consistent Care Ltd have owned Lytchetts. The inspection involved a tour of the premises, discussions with people living at the home, staff, management and the observation of routine tasks and daily interactions. Other information was gathered from documents including care files, staff files and home records. In advance of the visit, the home submitted a completed Annual Quality Assurance Care Homes for Older People Page 6 of 25 Assessment (AQAA) and surveys were received from 6 staff members, 1 healthcare professionals and 11 people living at the home. Care Homes for Older People Page 7 of 25 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 25 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 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a clear Statement of Purpose and Service User Guide and all new residents can be assured of receiving a contract which gives clear information about fees and their accommodation. New residents move into the home having had their individual needs comprehensively assessed ensuring that the admission process is well managed and person centred. Evidence: The home has a clear and comprehensive Statement of Purpose and Service User Guide, which sets out the aims and objectives of the home and what services and facilities are available. Lytchetts takes into account the varying needs of people interested in moving to the home and places an emphasis on being able to meet specific individual needs by liasing closely with the person and their family. Copies of letters sent to prospective residents seen, confirmed that Lytchetts was able to meet their needs. Care Homes for Older People Page 10 of 25 Evidence: The files of 4 people living at the home were viewed which all contained pre-admission assessments. Records covered areas such as behaviour, sleep, communication, continence and bathing and evidenced that a thorough and informative assessment had taken place. This ensures that sufficient information was gained so that a comprehensive care plan could be written; to ensure that the persons care needs could be met appropriately. Residents spoken with confirmed that their needs had been assessed by the manager and often in conjunction with their family, prior to moving into the home. The home ensures that the admission process and settling in period is tailored to the personal needs and requirements of the individual, making them and their relatives feel as comfortable as possible. Of the 11 respondents to the service user survey, all indicated that they had received enough pre admission information about the home prior to moving in and 9 said they had received a contract. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comprehensive systems are in place to provide staff with the information they need to meet the health and personal care needs of individuals and good management of medication ensures people are kept safe. Individuals continue to be treated with respect and dignity. Evidence: The care records of 4 people who live at the home were reviewed and found to contain assessments which then formed the basis for care plans, risk assessments and daily records describing the care of each person. There was evidence that care plans had been discussed with individuals or their families and signed by them. All care records seen were clear and detailed and showed evidence of other appropriate healthcare professionals visiting and being involved in peoples care. The care files and especially the daily entries by staff, were seen to be person centred, reflecting individuals needs and preferences and evidencing how these were met in practical terms, on a day to day basis. Staff also showed a sound understanding of residents health needs and were aware of any changes in a persons presentation, Care Homes for Older People Page 12 of 25 Evidence: physically and emotionally. Comments received from the healthcare professionals survey returned prior to inspection, indicated that they felt that the home always sought advice and acted upon it appropriately in managing and improving peoples healthcare needs. They also commented that the home did particularly well at managing individual care and assessments and was very supportive of people living there and visiting healthy professionals. Medicine handling, administration and recording are well managed, with all staff appropriately trained and regular medicine audits carried out. People wishing to selfadminister their medicines can do so following a risk assessment process, although all medicines were administered by the home at the time of the visit. Staff were observed to be compassionate and caring in their interactions with people living at the home and clearly well aware of individuals needs. Comments received in staff surveys stated that they felt Lytchetts has a happy and friendly environment and provides a good quality of life for people without taking their independence away. Care Homes for Older People Page 13 of 25 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. There is a good range of activities and social events planned by the home, which meet peoples social, recreational and religious needs. Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. A good choice of food is available, which provides a balanced diet and peoples individual needs are well catered for. Evidence: Lytchetts offers a weekly programme of social and recreational activities and ensures that time is also spent with individuals who are unable or reluctant to join in with group activities. Staff were observed engaging with people during the morning of the visit and it was evident that St Patricks Day celebrations had taken place, with decorations still being taken down. The registered provider spoke about his vision for the home in trying to promote individual rights and choices of people living there, whilst providing a stimulating lifestyle in a home from home environment. Surveys received indicated that whilst not everyone was satisfied with the range of activities and social events on offer for them personally, they felt that the home plnned these well and everyone had choice whether to join in or not. Care Homes for Older People Page 14 of 25 Evidence: Visitors are warmly received and able to visit when they choose, with some arriving and taking people who live there out during the inspection. Most meals are homemade and the menus showed that a varied choice was available. People appeared to enjoy lunch and most stayed in the main lounge area, where staff assisted them as needed, or otherwise ate in their room. Comments received indicated that people were happy with the food offered and said that it was very good. Care Homes for Older People Page 15 of 25 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. There are procedures in place to ensure that complaints are fully investigated and residents and relatives can be sure that their concerns will be listened to and acted upon. Adult protection policies are in place, in order to safeguard residents from potential abuse and harm and staff receive appropriate training. Evidence: The Commission or the home has received no complaints since its registration with Consistent Care Ltd and an appropriate and robust complaints policy and procedure is in place to deal with any concerns raised. No safeguarding referrals have been raised either and staff receive training in adult protection issues and were clear in their understanding of it when discussed with them. All people who responded to the service users surveys said they knew how to make a complaint and who to speak to. The health professional survey returned stated that they felt staff always responded appropriately regarding concerns about peoples care at the home. Care Homes for Older People Page 16 of 25 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. Lytchetts provides residents with a comfortable, safe and well-maintained place to live, which is clean and free from any offensive odours. Evidence: A tour of the premises found the home clean, fresh and well maintained with a clear on going maintenance plan. The AQAA submitted prior to the inspection also detailed any mprovements that had been made to Lytchetts environment and any further plans for this. Throughout the visit, there was a calm, peaceful atmosphere in the home with residents, staff and visitors making good use of different areas of the home. The laundry is well managed, with clearly labelled shelves for residents laundry and appeared clean and well equipped. There was evidence of good infection control procedures around the home, with staff observed appropriately using gloves and aprons and washing their hands. All staff have also received appropriate infection control training. Surveys received from people living at the home indicated that the majority thought the home was always fresh and clean, whilst some felt that the cleaning staff could benefit from having more time allocated to them. People commented that Lytchetts Care Homes for Older People Page 17 of 25 Evidence: has a lovely atmosphere and they felt very comfortable to be here. Care Homes for Older People Page 18 of 25 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. Residents can be confident that there are sufficient staff members on duty at all times and there is appropriate recruitment and training of staff, ensuring that residents will be competently cared for and protected. Evidence: Sufficient staffing levels are provided to meet the needs of the number of people living at Lytchetts. Of the 6 staff surveys returned 4 stated that they felt there were always enough staff to meet the needs of people living at the home, whilst 2 said usually. Comments received reflected that some staff felt they would like more staff on duty at times to better manage people with more complex needs. Resident surveys indicated that 5 respondents felt that staff were always available when they needed them, 5 usually and 1 said sometimes. The recruitment files of 2 staff were looked at and found to contain all the required documentation, including 2 references and evidence of identity. Criminal Record Bureau (CRB) disclosures were also present in the files and had been obtained prior to starting work. Recruitment procedures generally are of a high standard, with detailed interview records kept, supporting the homes decisions in who they appoint and for what reasons. The home has a good induction process in place and all staff have either achieved or Care Homes for Older People Page 19 of 25 Evidence: are working towards a minimum of NVQ level 2 in care. A thorough training needs assessment has been undertaken by an outside training company and courses planned as appropriate. All mandatory training was up to date and other recent courses taken included dementia care, diabetes management and care of the dying. It was recommended that a training matrix be introduced to provide an quick overview of what staff training staff had taken and timescales for updates. Most staff felt they received training which was relevant to their role, up to date and addressed the individual needs of residents. However, comments received also indicated that some staff felt more specialist training and input in communication methods would be beneficial. Further information on available training can be accessed through the following websites: www.picbdp.co.uk www.skillsforcare.org.uk Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a registered manager in place to ensure that the home is safely managed, well organised and run in the best interests of residents and a quality assurance system, which is based on the views of residents. Practices in the home ensure that the health, safety and welfare of all are promoted and protected. Evidence: The home has recruited a suitable manager, Sarah Gardiner, who was subsequently registered with the Commission shortly after this inspection visit in April 2009. She demonstrated dedication and competency throughout the inspection, is a Registered nurse and has many years experience of working in the care sector. In discussion, she clearly demonstrated a strong awareness of person centred care and her view of how that would be best achieved for people within the home. This was also reflected by the registered provider and it is clear that there is a strong management structure in place with the aim of running Lytchetts in the best interests of those living there. Comments received from staff indicated that they felt several issues surrounding Care Homes for Older People Page 21 of 25 Evidence: equipment and working practices were being addressed by the new manager. The home has good systems in place for internal audit quality assurance monitoring, including medicines audits, residents and staff meetings and residents surveys. A completed Annual Quality Assurance Assessment (AQAA) was also submitted to the Commission as required, prior to the visit. This identified what they do well, what they have improved during the past 12 months and their plans for improvement over the next 12 months. The Registered providers also visit the home on a regular basis and ensure that quality and management of the home is maintained to a high standard. The home does not manage the finances of any residents and invoice relatives for bills such as chiropody, after the home has initially paid it. Evidence of staff supervision was seen in staff files and is carried out on a regular basis. All aspects of health and safety looked at were well managed. Equipment is routinely tested and maintenance certificates seen were up to date. An up to date fire risk assessment is in place and appropriate records and action are kept regarding any accidents within the home. Care Homes for Older People Page 22 of 25 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 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 30 It is recommended that the home develop a staff training matrix to give an overview of all training received and when updates are due. Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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