Care Home: Old Rectory Nursing Home - Capenhurst

What the care home does well The staff who work at The Old Rectory are highly regarded so people living in the home and relatives know that care is of a good standard. People have their needs assessed so that they and their families know their needs can be met. The health and personal care needs of people living in the home are met. A varied menu is available so people living in the home are offered a nutritious diet that suits their preferences. A relative commented, " food`s lovely - enough to eat. Can have more - alternative if don`t like main choice." Staff try to stimulate people living in the home through a range of group and one to one activities. There is an ongoing refurbishment and improvement plan for the home so people live in homely and comfortable surroundings. The Old Rectory is well maintained so that people live in a safe and well maintained building. Various measures are in place to find out if the home is providing a good service. What has improved since the last inspection? Various improvements have been carried out to the internal and external environment of the home so people live in pleasant and comfortable surroundings. What the care home could do better: The home should ensure that a reliable tool is used to monitor the weight of people living in the home so that their health and nutrition can be accurately assessed. The displayed complaints procedure should provide people with up to date information about how to contact us if they wish. The safeguarding adults policy and procedure should give staff clear and accurate information about what to do if they suspect someone is being abused so that people are protected. The manager shoud ensure that recruitment procedures are robust so that prospective staff are thoroughly vetted and people living in the home are safe. Key inspection report Care homes for older people Name: Address: Old Rectory Nursing Home - Capenhurst Rectory Lane Capenhurst Chester Cheshire CH1 6HN     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: June Shimmin     Date: 0 2 0 9 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Old Rectory Nursing Home - Capenhurst Rectory Lane Capenhurst Chester Cheshire CH1 6HN 01513394810 01513397231 old.rectory@onetel.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Old Rectory Limited Name of registered manager (if applicable) Robert M`Connell Type of registration: Number of places registered: care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Dementia Code DE. The maximum number of service users who can be accommodated is: 35 Date of last inspection Brief description of the care home The Old Rectory is registered to accommodate 34 service users with a diagnosis of dementia. The home is a detached house which has been extended and converted. Accommodation consists of twenty four single bedrooms and five double bedrooms on two levels. Access between floors is via a passenger lift or stairs. None of the bedrooms at the home have en-suite facilities, wash-hand basins are fitted in all rooms. The home is situated in the village of Capenhurst with easy motorway access. Long and short -term placements are offered and the home employs a team of 1st Care Homes for Older People Page 4 of 26 Over 65 35 35 0 5 0 1 2 0 0 9 Brief description of the care home level registered nurses and support workers for the provision of nursing and personal care. The current charges for the service are from #467.10 to #598.99. This does not inlcude the nursing contribution of #106.30 where this is appropriate. 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: The last inspection on this service was completed on 25 September 2007. The overall quality rating for this service is two stars. This means that the people who use the service experience good quality outcomes. This unannounced inspection visit took place over two days and lasted nearly seven and a half hours. One regulatory inspector carried out the visit. The report will refer to we and us as it is written on behalf of the Care Quality Commission. This visit was just one part of the inspection. Other information received was also looked at. Before the visit the manager was asked to provide information about the home as part of this inspection process. We sent questionnaires to people living in the home, relatives and staff members to find out their views about The Old Rectory. We also spoke to several people living in the home, a relative and staff members during our visit to the home. Their views are incorporated into the findings of this report. During our visit we looked at various records and the premises. Records of care plans, Care Homes for Older People Page 6 of 26 medication and staff training records were also examined. 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. Care Homes for Older People Page 8 of 26 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 9 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 10 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 have their needs assessed before admission to the home so they know that those needs can be met. Evidence: We looked at the assessments of two people who had recently moved into the home. The registered manager told us that either he or one of the registered mental health nurses carry out these assessments so these are done by someone who has the correct knowledge and skills. One assessment was of a better standard than the other and provided more information about the needs of the person being admitted. There was however sufficient information about both people to enable staff to draw up a care plan detailing how those needs would be met. 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. Promotion of health is taken seriously, peoples welfare is monitored and health needs are met. Evidence: We looked at the care plans of four people living in the home, three of these in detail. Where this was possible we spoke to the people who had been admitted. Care plans for most care needs were drawn up within five days of admission so that care needs could be promptly identified and staff would know what to do to meet those needs. Various risk assessments were also written within this timescale so that any identified risks could be monitored. The care plans were not always written in a way that focused on the individual so they were not person centred. They had been kept under review so that changing needs were monitored and care plans amended accordingly. We looked at one care plan as the person had a poor appetite to find out if records were monitoring this. The records indicated that the person had gained twelve kilograms in one month, which was very unlikely. This means that the methods of weighing people were possibly unreliable. The home also did not use a recognised tool, the Body Mass Index [BMI], to find out the degree of weight loss. The registered Care Homes for Older People Page 12 of 26 Evidence: manager told us that there were no incidences of pressure ulcers in the home. This shows that care standards in the Old Rectory are good as a number of people are nursed in bed and staff are taking appropriate steps to protect people in their care. Records also indicated that, where appropriate, advice was sought from a variety of healthcare professionals such as GPs, specialist nurses and other professions allied to health. The privacy and dignity of people living in the home was maintained. Care staff approached people in a gentle manner and gave them assistance in a supportive and caring way so they were well looked after. We also looked at the way in which medication was being managed. This was of a good standard overall. We pointed out that reasons should be recorded when medication is omitted so the home can demonstrate that it has taken reasonable steps to ensure that people receive their prescribed medication. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home will enjoy a good quality of life through the provision of a varied programme of activities and a nutritious diet. Evidence: The Old Rectory employs two activity coordinators who provide a range of one to one and group activities. During our visit we observed one activity coordinator interacting with small groups of people and they appeared to enjoy these sessions. We were told that although the activities are provided from Monday to Friday the activity coordinators will work flexibly to cover special events such as the Summer Garden Party. Staff in the home recently completed a sponsored walk of Moel Famau to raise funds for a summer house. The manager told us that the home also has good links with the community and that representatives of Chester Zoo bring in animals for residents to enjoy and look at. The standard of catering at the home is good. The menus are drawn up using a tool to highlight any nutritional deficiencies in the diet so that people are well nourished if they eat their meals. During lunch we observed several people, one who was eating independently and others who were being assisted. However, one person who appeared underweight could have received more assistance. We were told that many people living in the home need help at meals so the lunch period has been extended Care Homes for Older People Page 14 of 26 Evidence: to ensure that everyone is able to enjoy their meal at their own pace. The manager has also introduced a menu card, describing the meal in words and pictures. However, the size of the print and pictures was quite small so might not be fully visible to everyone. A relative said that she visited frequently and was made to feel welcome. We also asked how the home was meeting the needs of people from two other European countries and a nurse described how measures were being taken to meet their specific needs in relation to language and culture. 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. Complaints are well managed but a lack of clarity in the safeguarding adults policy might mean that staff are not fully aware of their responsibilities and so people living in the home may not be protected. Evidence: We looked at the complaints procedure and complaints received by the home. The procedure displayed in the main entrance to the home was five years out of date and did not provide our contact details if anyone wished to speak to us. However, the registered manager had produced a new leaflet about the home with the correct information although the print was very small and might be difficult to read. The registered manager provided us with evidence that complaints had been fully investigated and appropriate action taken following these complaints. This means that people would know their concerns are listened to and taken seriously. We also looked at the safeguarding adults policy but this did not provide clear information about the correct procedure to be followed and whom to contact if an allegation of abuse was made so that in the absence of the manager the appropriate action might not be taken. We also spoke to several staff members who were unsure about whom to contact other than the manager if they suspected someone was being abused. The manager was aware of the homes responsibility in relation to Deprivation of Liberty and had done risk assessments for people living in the home to ensure they were protected. 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 Old Rectory is well maintained so that people live in comfortable and homely surroundings where their health and safety is promoted. Evidence: A number of improvements to the internal and external environment have been made during the last two years. Externally there is a new paved area in the garden where a summer house is to be placed. The approach to the home is flagged and the steps are non slip and safe and with a slope for wheelchairs. The manager told us that volunteers have helped to improve the garden areas and that the home has a regular gardener so that the external environment provides a pleasant place for people to sit and enjoy. Internally there has been an extensive improvement programme including laminate flooring to the ground floor corridors. New lighting has been provided which is suitable to the environment. The manager told us that a relative has provided two tactile boards which are seen as good practice in homes for people with dementia. The dining room has been moved to a different area of the home but will only accommodate ten people. There are three small lounges and one lounge has a computerised information strip which the home uses to send messages such as the day, date or someones birthday. The home has reduced the number of double bedrooms to five and everyone in the home has access to their own sink so there is no risk of infection from the sharing of sinks. The home smelled fresh most of the time and measures were in place to prevent to the spread of infection in the home. There Care Homes for Older People Page 17 of 26 Evidence: was also a variety of equipment provided to support people with varying degrees of disability so their needs would be met. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels at The Old Rectory are generally satisfactory and staff are skilled in their role so that people receive the care they need. Recruitment checks need to be recorded more thoroughly to show the home has made sure that new staff are suitable to work with the people who live there. Evidence: We spoke to several staff during our visit. All said they enjoyed working at the home, one stating, care is second to none and another, I like working here. We looked at staffing levels in the home and these were sufficient to meet the needs of people living in the home. There had been two cooks working at the home but at the time of our visit, there was only one cook working seven days a week. Although the cook said that he was happy to work these hours, this is not ideal. The registered manager told us that he is trying to recruit a further cook. We looked at the recruitment records of three people and these were not of a good standard. The home had not obtained all necessary information about employees, including security checks so that people living in the home were not fully protected. There were no initial security checks [POVA first] in place for the three staff. The manager told us that he had done the full security checks [CRB] but had destroyed Care Homes for Older People Page 19 of 26 Evidence: them without keeping a record of the CRB number so that we could not verify that they were satisfactory. The registered manager had accepted the CRB of two staff members from their previous employment and did not realise that this was unsatisfactory and that new CRBs needed to be obtained for all new staff members. He applied for further CRBs several months after they started work at the home. There was a reference from one person from their previous employer but not a second reference. The registered manager told us that two staff members had worked in a Scottish care home but there was no reference to this on their application form. Nor was there a reference from the previous care home where they had worked. The work permits of two staff members were due to run out within a week of the inspection but the registered manager was unaware of this. He told us that he would send us written confirmation that their work permits had been renewed and has since told us that one person has been given the right to stay. The manager showed us the induction records of new staff which were fully completed so that staff had received the necessary training to start work at the home. The home has a training matrix so that it is known when staff are due to undertake refresher training in various mandatory subjects such as safe moving and handling. The registered manager told us that nearly all the carers working at the home have achieved a minimum NVQ2 in care qualification so are skilled to carry out their role. A number of staff have also attained NVQ3 in care. The remaining staff are being supported to start their NVQ training during the coming months. Staff also receive supervision on a regular basis so they are given feedback about care issues and support regarding training. Care Homes for Older People Page 20 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. In most areas The Old Rectory is well managed and quality assurance procedures are in place to monitor the standards of care at the home to make sure it is being run in the best interests of the people who live there. Evidence: The manager of the home is a registered mental health nurse and is registered with the Care Quality Commission. He has achieved NVQ4 in management and is an experienced manager having managed the home for a number of years. The manager gave us information before the inspection [AQAA] in which he said that he is working towards NVQ5 in management. The manager is supported by a care manager who acts as his deputy. Staff said that they mainly had contact with the care manager and did not often see the registered manager. The manager told us that various measures are in place to assess the quality of the services at The Old Rectory. The manager showed us a number of improvements that had been introduced since the last Investors in People review in 2006. These included regular staff supervision and meetings so that staff are able to put forward their views Care Homes for Older People Page 21 of 26 Evidence: about how the home is run and make a contribution. A representative of the owners visits the home monthly and prepares a written report about how the home is managed. Although the manager said that staff questionnaires had been sent to us we did not receive them so were unable to incorporate written staff comments in this report. The manager told us that the home does not have any responsibility for resident finances. We looked at fire safety records and these were satisfactory. The manager told us that several issues raised by the fire officer had been put right. We noted that the moving and handling instructor had not done refresher training for several years so might not be fully up to date. The manager told us in the AQAA that the homes equipment and facilities had been serviced and maintained on a regular basis so that people living and working there are protected. Care Homes for Older People Page 22 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 23 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 29 19 The registered person must 01/12/2009 ensure that initial and full security checks are obtained for all staff and records of these retained in the home so that people living in the home know that thorough recruitment checks have been carried out and they are protected 2 29 19 The registered person must 01/12/2009 ensure that two references are obtained for all staff and one that relates to the persons previous employment so that people living in the home know that thorough recruitment checks have been carried out and they are protected Care Homes for Older People Page 24 of 26 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 8 The registered manager should use a reliable tool, such as the Body Mass Index, to find out if people are losing or gaining weight so that their nutrition can be accurately monitored. The complaints procedure displayed in the home should include our up to date contact details so people can contact us if they wish. The safeguarding adults policy should be reviewed so that it tells staff what to do and whom to contact if they suspect someone is being abused The moving and handling instructor should undertake refresher training so that she is fully aware of current safe moving and handling techniques and so that staff are being taught to move people safely. 2 16 3 18 4 38 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. 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