Care Home: Park Farm Lodge Care Home

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What the care home does well Each person who lives in this home can be assured their needs will be assessed in full before they move in. The Home offers a genuine commitment to care with an open and personable approach, which reflects the homeliness of a confident relationship between carers and people living in the Home. Staff are friendly and understand the needs of the people living here. People can feel confident they will be treated with respect and dignity at all times. We were told, "Friendly staff always willing and to help, I am looked after very well". Effective assessment, care planning and review of peoples needs are meaningful and robust in ensuring a good standard of care. The management demonstrated a professional approach in maintaining an environment suitable to the care of the elderly, including a user survey which provided meaningful information, and attracted an appropriate response. There is a constant appraisal and review process of facilities and services to maintain that environment. Comments we received from people living in the Home, and relatives we spoke with: "I am very happy with everything the Home does to care for my mother. I have no worries or complaints". "The staff at Park Farm Lodge are excellent, they are friendly, caring, conscientious and always helpful". "Always attentive and patient, providing good medical and nursing care, staff are friendly and professional". We recognised that the care planning process has a diligent pre-admission assessment, risk assessment, care planning and monitoring of individual needs; person centred, and effective in formulating a satisfactory standard of personal care. Our discussions with those people using the service and visitors, recognised the confidence in this highly personable attitude and approach to care. We acknowledge the energy and initiative taken in the promotion of people`s dignity and representation within the unit, and involvement in projects enabling people to continue to maintain links and relationships within their local community, as an extension of the care home. We acknowledge the arrangements made to recruit and appoint the appropriate staff through a sound recruitment and induction programme, complemented with an extensive training opportunity and meaningful staff supervision. We considered that the overall management style directed by the Care Manager demonstrated a satisfactory approach in maintaining a caring environment fit for care of the elderly. What has improved since the last inspection? We found that the home has addressed the issues raised in the last CSCI Inspection Report, with an increase in the influence of activity co ordination, that reflect the interests of the people in the home at any one time. We recognise improved induction and training undertaken, to ensure that staff are proficient and aware of changing needs in the care environment, especially in Dementia care and Abuse awareness. We recognize the improvements made in care planning and the introduction of `Dignity Champions` in the Home, reinforcing that health and personal care, which people receive, is based on meeting personal needs, with clear principles of respect, dignity and privacy put into practice. Our discussions with people clearly identified a relaxed and informal atmosphere in which the people`s needs were paramount. We evidenced an improvement in procedures and practices, influenced by feedback from people and audit processes. Staffing levels are much improved, to complement the significant progress made in staff training and supervision, with a result that care staff are more involved in promoting person centred care to a significant level. We have recognised that during this period since the last inspection that resources have been allocated to upgrade facilities and services to create a more homely and pleasing environment for people to live in. What the care home could do better: We have recommended that the Provider considers to present the Service User Guide in an audio version, to help those people challenged with poor eyesight to make an informed decision as to whether the Home will meet their needs. We discussed the expected need of people receiving nursing care on night duty, and advised a review of the coverage of trained staff available per night for the Home as a whole. We have also suggested that the process of tracking the disposal arrangements for discontinued medicines requires a review to complete the secure audit trail. We determined that the general fabric, furnishings and decor standards in certain areas need to be maintained and upgraded, to provide people with a comfortable and safe living environment. We identified specific areas for attention including the practice of using inappropriate notices in bedrooms, which need to be placed more discretely, to review the use of communal stocks of items of clothing, and ensure that each person who needs a movement and handling sling is issued with their individual slings. Key inspection report Care homes for older people Name: Address: Park Farm Lodge Care Home Park Farm Road Tamworth Staffordshire B77 1DX     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: 0 8 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 32 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 32 Information about the care home Name of care home: Address: Park Farm Lodge Care Home Park Farm Road Tamworth Staffordshire B77 1DX 01827280533 01827288544 park_farm_lodge@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Four Seasons Homes (No 4) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) care home 80 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 80. 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 (DE) 40, Old age, not falling within any other category (OP) 40, Physical disability (PD) 40 Date of last inspection Brief description of the care home This is a purpose built care home with nursing which can accommodate 80 people in the above categories. The home is situated on the outskirts of Tamworth and there is a bus stop outside the main entrance, facilitating easy access for visitors. Local towns Care Homes for Older People Page 4 of 32 Over 65 0 40 0 40 0 40 Brief description of the care home are accessible by car or public transport. There are two levels, which can be accessed by lifts or stairs. There are wide corridors with grab rails fitted throughout the building. The gardens are accessible by wheelchairs and are well maintained, appropriate seating facilities are provided. There is adequate communal space for people using the service, and all bedrooms are single occupancy with en suite facilities. Bathrooms and toilets are appropriately situated, and bathroom and toilet doors are painted in alternative colours, which assists people in locating them. The interior of the property is well maintained; clean and the decor is set to a good standard. Communal areas are spacious and comfortable. Small, quieter sitting areas are available on both floors. Adequate parking is available to the front and side of the property. The full range of charges were not detailed in the services Statement of Purpose or Service User Guide documents as routine. The reader may wish to contact the service to obtain more detailed and up to date information about fees. Care Homes for Older People Page 5 of 32 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 conducted this unannounced inspection with the Registered Care Manager, the Area Manager from Four Seasons, clinical managers, senior nursing and care staff on duty, whose input contributed to this report. We also had the services of an expert by experience, a person who, because of their shared experience of using services and ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in, or use the service. Our inspection of the building allowed us free access to all areas, and open discussion with people who use the service, relatives and staff. There were 74 people in residence on the day of our inspection. We looked at how care is being arranged and supported for six elderly people with nursing, personal and dementia care needs, who use this service in depth. This is part of our case tracking process and helps us makes judgements about the homes abilities to meet peoples needs. We also looked at other information such as complaints, incidents, events and other professional reports. Care Homes for Older People Page 6 of 32 We took the opportunity to speak with a number of people who use the service, relatives and members of staff, who took an active role in the inspection process, and contributed to the subsequent report. We acknowledged receipt of the Annual Quality Assurance Assessment (AQAA), and nine survey forms we issued to people who use the service, and their relatives, some weeks before the inspection. The AQAA is a selfassessment that focuses on how well outcomes are being met for the people using the service. It also gave us some numerical information about the service. We inspected a sample review of administrative procedures, practices and records, confirming consistent good practice and effective management. There followed a report feedback, in which we offered an evaluation of the inspection to the Registered Care Manager, the Area Manager and clinical managers, indicating those recommendations resulting from the inspection. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? We found that the home has addressed the issues raised in the last CSCI Inspection Report, with an increase in the influence of activity co ordination, that reflect the interests of the people in the home at any one time. We recognise improved induction and training undertaken, to ensure that staff are proficient and aware of changing needs in the care environment, especially in Dementia care and Abuse awareness. We recognize the improvements made in care planning and the introduction of Dignity Champions in the Home, reinforcing that health and personal care, which people Care Homes for Older People Page 8 of 32 receive, is based on meeting personal needs, with clear principles of respect, dignity and privacy put into practice. Our discussions with people clearly identified a relaxed and informal atmosphere in which the peoples needs were paramount. We evidenced an improvement in procedures and practices, influenced by feedback from people and audit processes. Staffing levels are much improved, to complement the significant progress made in staff training and supervision, with a result that care staff are more involved in promoting person centred care to a significant level. We have recognised that during this period since the last inspection that resources have been allocated to upgrade facilities and services to create a more homely and pleasing environment for people to live in. 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 9 of 32 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 32 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. The needs of people are appropriately assessed before they are offered a place. They and their relatives can be confident that the service will be able to meet their needs. Evidence: We examined the services Statement of Purpose and Service User Guide, and found them to provide an informative description of the Homes aims, objectives, and the way it operated. We acknowledged that the documents were presented to all enquirers, and that information concerning fees payable were not included in the Service User Guide. We saw that the Statement of Purpose could be produced in large print, as and when necessary. We consider that the Service User Guide presented in an audio and pictorial version would help people to make an informed choice. It is stated in the AQAA, and we recognised that the Statement of Purpose and Clients Charter represents the basis on which the home operates upon, offering those people who may use the service, and their relatives, the opportunity to make an informed choice about where to live. Comments received from surveys we sent out before the Care Homes for Older People Page 11 of 32 Evidence: inspection to people who use the service : When we met the nurse who came to see us at home we were impressed with her friendly advice in explaining everything about Park Farm. We have not been disappointed. They are very positive and helps people to live their lives, respects everyone, but in a family setting. Its good, we received plenty of comments and descriptions from friends and people who knew the home. What information we received was very helpful and informative. Through our case tracking of six peoples care records we clearly identified that the Care Manager, or her nominated deputy, at the point of reference, conducted the preadmission assessment. We also acknowledge that senior carers often accompany the manager, which has proven to be meaningful in the preparation of the care planning, and social activities programme. We found that the documentation identified a clear dependency assessment, forming a comprehensive foundation for care planning to meet needs, which included a copy of the care plan from social services, prior to admission. The objective is for this assessment to be produced with the full involvement of people who may use the service and their family, allowing them to influence the direction of care. We found this to be true, with each individual having a plan of care, which included a detailed care plan, daily care programme, risk assessments with goals and outcomes. Any special needs of the individual were discussed fully and documented, ensuring their personal needs would be met. During the course of our inspection we had opportunities to sit and talk with people who use the service, staff and a number of visitors. We found evidence that much care had been taken in involving people, and their families in the admission process. From those discussions it was clear that people are able to visit and assess the facilities and suitability of the Home at any reasonable time, and to meet with staff and management. Staff are aware of the special period of personal anxiety that people have under those conditions, a point well illustrated when talking to people, and examining records on case tracking. Care Homes for Older People Page 12 of 32 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, which people receive, is based on meeting personal needs, with clear principles of respect, dignity and privacy put into practice. Medicine administration systems are safe and secure. Evidence: We found that the care records clearly showed that this standard is well met, maintaining a high quality process of assessment. Those care records and case tracking we examined provided clear evidence to show that the pre-admission assessment; Care and Health Assessment Process (CHAP) offers the foundation for a meaningful, and detailed care planning process, including risk assessments, for a wide range of observations, including mobility, danger of falls and nutrition, and is supported by relevant Social Services reports. We found that the profile of each persons social, physical and psychological status offered an individual plan of care, based upon dependency assessment and activities of daily living, frequently reviewed in an individual plan of care that is reviewed monthly, to reflect their changing needs and adapting care profiles, supported with a Care Homes for Older People Page 13 of 32 Evidence: substantial and very informative daily progress report. We acknowledged that monitoring systems following a process of goals, care and evaluation of good quality care plans. Risk assessments are carried out on an individual basis and reviewed as required, taken from the CHAP, and enhanced upon by the care planner, these include tissue viability, mobility, continence and nutrition. We confirmed that those people who use the service, families and friends are invited if possible, to participate in the care planning process and established monitoring systems. Through case tracking, our discussions and inspection of records, it was confirmed that the Home arranges for health professionals should special health care needs be recognised, with each person having access to a local Doctor, Dentist, Optician, Chiropodist, specialist Nurse and Occupational Therapist as required. Our observations showed that generally people using the service appeared to be content, comfortable and happy with their lifestyle, complimentary regarding the quality of their lives and the care they were receiving. Comments we received from people living in the Home, and relatives we spoke with: Always attentive and patient, providing good medical and nursing care, staff are friendly and professional. Mums health has improved since she has been in Park Farm Lodge and she is very settled there. Provide a good standard of care by carers who know my needs and take time to listen, even though I have limited speech. The staff at Park Farm Lodge are excellent, they are friendly, caring, conscientious and always helpful. From an examination of records, and inspection of facilities, we confirmed that the administration of medicines is of a good standard to maximise protection for people who use the service. We found that the Care Manager is responsible for overseeing all matters relating to medicines, with a senior nurse taking operational responsibility for day to day actions. We confirmed that the Care Manager has effected a well developed, and smooth process of ordering, receiving, storing, and administering medicines. The process of tracking the disposal arrangements requires a review to complete the secure audit trail. Working records were seen to be complete and easy to follow through, with no observed breaches in the administration system, although one prescription required clarification by the doctor to ensure a clear understanding of administration. All six people being cases tracked were found to have appropriate Care Homes for Older People Page 14 of 32 Evidence: medication. Controlled Drug management was comprehensive. In our examination of care records, we established that a policy and procedure on care of the dying and death had been introduced to meet individual needs, and were in place with the full knowledge of those who use the service and relatives. We have recognized the Homes involvement in the Care homes Improvement Service for end of life care, and have accessed training for key staff. We were informed that there is an involvement in a pilot project linking with the community to enhance interaction and interests to which each person is having their life history recorded, with their permission. We noted that two staff have been identified as Dignity Champions within the Home, and Park Farm Lodge has been accepted to work towards PEARL accreditation (Positively Enhancing And enriching Residents Lives), a project specific to the Dementia care unit. It is stated in the services Statement of Purpose and the AQAA, that independence, privacy and dignity are encouraged, with the full involvement of family in all matters concerning the well being of people. This was confirmed in our discussions with people who use the service, visitors and staff. Relatives and friends have freedom of visiting, which emphasised the importance of maintaining social contact. Our discussions with people confirmed that individual spiritual persuasions, and individual diversity was seen to be respected. We were impressed with the confidence and closeness within the Home and the mutual respect that prevailed. Our discussion with visitors on the day was a fruitful exchange, with all being very complimentary of care. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights to live a meaningful life are promoted, and people are offered opportunities to exercise choice and control over their lives. People are offered a healthy, well balanced diet. Evidence: From talking to people and staff we confirmed a continuing daily routine that is flexible and non-institutionalised, offering choice for meal times, personal and social activities including recognition of varied religious needs. Our discussions with people who use the service and staff, identified a confident, relaxed atmosphere in which peoples needs were respected, with the security that there are familiar events to the day they could relate to. We acknowledge that Park Farm Lodge employs an activity coordinator in social activities who was seen to offer one to one and group activities, and more diverse programme of activities and individual assessments of need. The work of the coordinator is recognised as an important part of the care process, as evidenced in examination of records, and discussion with staff, with a regular programme of activities identifying social events, which included themes and entertainment Care Homes for Older People Page 16 of 32 Evidence: organised by the Home. Peoples life histories are discussed and used to provide a profile basis for individualised social care, offering choice and support, although there remain a number of people who have not as yet had the profile added to the care record. On the day of inspection the activity coordinator was seen to be reading to a lady, and was fully engaged in a busy programme of individual and group activities throughout the course of inspection. We recognize the initiate taken in the promotion of peoples dignity and representation within the unit, through the recognition of two Dignity Champions; a Registered Nurse and a senior carer. The Home has a participation in a pilot project entitled Connecting with your community, enabling people to continue to maintain links and relationships within their local community as an extension of the care home, and have been accepted to work towards PEARL accreditation (Positively Enhancing And enriching Residents Lives), a project specific to the Dementia care unit. Together the aims adhere to principles underlying the dignity in care campaign for the elderly, a positive state of attitude invigorating plans and action on staff training and the environment. Comments: The staff are friendly and welcoming and most of the carers are conscientious and affectionate towards EMI residents. I am very happy with everything the Home does to care for my mother. I have no worries or complaints. dictated to daughter. I would find it helpful if staff could spend more time with me, when doing tasks. Families and friends are actively encouraged to participate in the daily life of the home, with no restriction being placed on visiting times. During the course of the inspection we saw staff and visitors interact with people in a positive and polite manner. Comments from visitors, one who came every day were: The Homes staff treat people with respect, Park Farm Lodge is a big improvement on other homes we have experience of. The Home is really very good, all of its staff are very committed to caring for their residents. It is stated in the Statement of Purpose and AQAA, that personal choice, dignity and self determination are respected in policy and action, which we found to be true. Those individuals rooms we inspected showed a very positive influence of personalisation in the inclusion of belongings, some furniture and general decor, demonstrated a degree of expressed individuality. We acknowledge that there are active plans to upgrade the facilities for dementia care to accompany the initiatives on Care Homes for Older People Page 17 of 32 Evidence: care planning and staff training. We found that the good standards of catering at Park Farm Lodge continues, offering a service to which all those people we spoke with were complimentary of all aspects of quality. A menu on a four weekly cycle offered a wholesome, varied and excellent choice. We confirmed that the cook knew each person using the service, and some of the relatives. We discussed diversity with the cook, who indicated an awareness in meeting individual needs; there were no special cultural needs at the time. Individual preferences were conveyed to the catering staff, who met with, and discussed their requirements. A very pleasant light lunch of soup, sandwiches and dessert was offered, with a main meal of braising steak planned for tea time. All meals were served in pleasantly furnished and clean dining rooms, and staff were seen to offer discreet assistance to those who required it. It was noted that as part of the PEARL programme, a theme was running to promote dignity when assisting residents who require help with eating and drinking, completed over two sittings to facilitate a closer commitment. The choice of dining room, lounge or bedroom was at the discretion of people in the home. People interviewed confirmed that that the quantity and quality food provided was good, and preferred to eat their main meal later in the day. Care Homes for Older People Page 18 of 32 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 are given opportunities to freely express any concerns, and these are quickly responded to. People are protected from abuse, and their human rights are promoted. Evidence: Through the course of inspection we confirmed that peoples legal rights are protected by the systems in place in the home to safeguard them, including the continual review and assessment of care planning, and policies in place, including the complaints procedure. The complaints policy was seen and records examined. All people who use the service had received information on the procedure to complain, including reference to the Care Quality Commission (CQC). On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. Case tracking confirmed the effectiveness of a Provider, Care Manager and staff sensitive to peoples needs, and a readiness to test the robustness of their information and report structures. No complaints had been received by us since our last inspection. The overall policy of openness and transparency was acknowledged. We were informed that all the people who used the service had received information on the procedure to complain, including reference to us. Discussion with the Care Manager confirmed that there continues to be a satisfactory protocol, and response to anyone who may report any form of abuse, to ensure Care Homes for Older People Page 19 of 32 Evidence: effective handling of such an incident. We recognize that an on going allegation is presently being handled through the recognized procedure and authorities in a responsible manner. The Annual Quality Assurance Assessment completed by the service prior to the inspection confirms all staff employed in the last 12 months have undertaken a satisfactory Criminal Records Bureau (CRB) check, confirmed by examining three staff files. It is positive that all staff have had training to highlight their responsibilities under the Mental Capacity Act. Booklets from the General Social Care Councils Code of Conduct are given to all staff to help reinforce the induction and training programmes. Staff induction and in house training programmes clarified the responsibilities of all staff in their daily contact with people who use the service, especially their privileged position in protecting those people from abuse, of all natures. Care Homes for Older People Page 20 of 32 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 Home provides a safe, well-maintained, clean and comfortable environment for the people who use the service, which encourages independence. Evidence: External access is satisfactory for visitors, with adequate parking. The grounds were found to be generally well maintained, with an attractive patio square, sheltered with satisfactory seating areas and attractive herbal garden sections, well attended and popular with people living in the home and relatives. The state of repair and maintenance is generally good, offering a comfortable, homely, yet secure environment. The location of Park Farm Lodge is conducive for a care home, the premises were fit for purpose, clean warm and tidy, and being satisfactorily maintained. At pre-admission assessment the Care Manager assesses each individual persons needs for equipment and necessary adaptations. A letter confirming those arrangements was seen to have been sent on to confirm admission arrangements. Internal access as facilitated with ample fittings of hand and grab rails in well lit and airy corridors, facilitating wheelchair access throughout all areas of the home. It was noted that several corridors were in need of redecoration, and fitting out to meet dementia care needs, especially in pathway recognition, reminiscence and familiar recognition. We confirmed an effective staff call system throughout the home, and Care Homes for Older People Page 21 of 32 Evidence: satisfactory hoists and a range of aids and adaptations for people who are dependent, including adequate numbers of good quality nursing, variable height and profiling beds available. All external doors are alarmed telling staff that one has been opened and that someone has gone outside. The Care Manager confirmed to us a willingness on the part of management to meet any reasonable demand for special needs. Personal electrical equipment (PAT), that is televisions, radios, etc, where seen to be tested. All communal areas are of a high standard, offering social as well as private reflection, as the mood takes. Eight lounge areas allow activities to be presented in a very pleasant, animated area of the home, or a quiet area with pleasing furniture and fittings of good quality. A designated smoking lounge is identified on each floor. The dining areas are well furnished, and presented to provide a conducive environment to enjoy a good meal. Staff supervision is available throughout the day, and was observed during the inspection; we also recognised the attention given to people by the activity coordinator. Our inspection of bedrooms found most well equipped and maintained to provide for peoples individual needs and preferences, personalised, with most displaying the personal furniture and belongings. We did note the use of information and instruction notices on display in bedrooms, which need to be placed more discretely. Efforts had been made to provide a homely atmosphere, and the decor in most areas was found to be of a good standard, with a development programme for continuing upgrading of the dementia care unit planned for to meet the accreditation criteria for PEARL accreditation. There were several rooms in need of upgrade to meet an acceptable standard on both floors, with some of the original furniture in need of replacement, an issue discussed with the maintenance man and Care Manager for early attention. Each bedroom has adequate space to assist with personal care and dressing assistance. Nevertheless we found the overall quality to remain of a good standard, presenting an homely and comfortable environment. A locked facility and lockable bedroom doors was available on request, following suitable risk assessment. Several people we spoke to expressed a sense of belonging and satisfaction in the quality and presentation of their living areas. Two comments we received from the surveys we sent out earlier: I really like it here, the bedrooms are just what I wanted, with the nice decoration and always clean and warm. When I want something the staff go out of their way to help me, and the handy man is always helpful and cheerful. Need to have better furniture in the rooms. The bedroom could do with being painted and refreshed. Care Homes for Older People Page 22 of 32 Evidence: People have the provision of sufficient and suitable lavatories and washing facilities within the home. There remains an unused bathroom doubling up as storage areas, mainly due to the extensive en suite and shower facilities. Adequate attention has been given to ensure maximum privacy within risk assessed boundaries. Toilets and bathrooms were located on both floors and were in close proximity to bedrooms and communal areas. The standard and presentation of all the toilets and bathrooms were of a good quality, clean and uncluttered. Sluice facilities have suitable arrangements to assist in control of infection. Notices regarding chemical handling in the areas that store chemicals are displayed. The housekeeping services in the Home were seen by us to be of a generally good standard. Comments from a survey we sent out and received on the day: Park Farm Lodge is always light, clean, and odour free, accidents are quickly cleared. Always clean and smells nice, bedrooms and bathrooms always clean and tidy. The home achieves a high standard of cleanliness. Heating and ventilation were found to be satisfactory, and lighting was domestic in style. Aids, adaptations and equipment were available throughout the Home. Fire equipment was inspected and seen to be serviced and up to date. The extensive laundry was well organised and equipped to a good standard, the flow of laundry through the process enhance cross infection control. Notices regarding chemical handling in the areas that store chemicals are displayed. A clothing identifier would enhance the security of peoples clothing. We observed that there were some items held as unidentified stock that could be held for communal use, a practice for review. We noted that lifting slings are used on a communal basis, to which we agreed that everyone in need of a lifting sling be given their personalised issue. The Annual Quality Assurance Assessment completed by the service prior to the inspection confirms that the building complies with the requirements of the local fire service and environmental health department, and records are kept accordingly. Care Homes for Older People Page 23 of 32 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. Staff in the Home are trained, skilled and in sufficient numbers to fulfill the aims of the unit and meet the changing needs of people using the service. Evidence: We confirmed that there were 74 people living in the home on the day of the inspection. Three weeks of staffing rotas showed to us a much improved balance between skills, experience and numbers to provide a good standard of care, although there remains a weakness in the overall coverage for night duty, requiring three trained nurses for 65 people receiving nursing care on both floors. The Registered Manager, who is supernumerary, is supported by a Unit Managers and an overall satisfactory complement of Registered Nurses and care staff. We recognize that the trained nurse establishment has an equal complement of mental health and general nurses. Discussions with staff also confirmed their commitment to providing a quality service and their awareness of the principles of good practice. The Home has an activity coordinator, and a satisfactory complement of housekeeping, laundry, maintenance, administrative and catering staff. We sampled four staff files, and found them to be consistent and up to date, recognising that the management have established a comprehensive procedure for interview, selection and appointment of staff, reinforcing the policy that the thoroughness of staff selection has a significant effect upon the provision of care to Care Homes for Older People Page 24 of 32 Evidence: ensure protection of people. It was evidenced that Criminal Records Bureau (CRB) checks have been made, and contracts of employment are up to date. Ongoing personal and training records were kept secure in accordance of the Data Protection Act 1998, and policy clearly states an equal opportunity position. Staff are employed in accordance with the Code of Conduct and practice set by the General Social Care Council. We saw that all new team members receive a thorough induction programme, and an ongoing training and development plan for all staff. The records we examined showed that 13 care staff are in receipt of National Vocational Qualification (NVQ) level II or level III, with a further four undertaking NVQ training at the time of inspection. Six staff have been identified for training, and there are nine members of staff certificated first aiders. We acknowledge the achievements in providing evidence to show a substantial account of a meaningful schedule of training, to meet mandatory and specific demand. The Care Manager was advised to seek full training and procedural guidance on the Mental Capacity Act and Deprivation of Liberties for all senior staff. Comments we received from people living in the Home and staff The staff are friendly and welcoming, and most of the carers are conscientious and affectionate towards EMI residents. We have a great deal of respect for the staff in everything they do for dad, always have time, even when rushed off their feet, they do their best they can. We get lots of staff training, gaining more experience, and confident in our work and in dealing with problems. I have always found the senior staff very supportive and knowledgeable. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that the home is run in their best interests. The ethos of the service is based on openness and respect. The care team, through good working practices, promote the health, safety and welfare of people who use this service. Evidence: We acknowledge that the Care Manager Laura McCormick has continued to demonstrate clear competence in managing Park Farm Lodge, in establishing a solid professional management style that has been implemented, to achieve good standards of set aims, objectives and care. An experienced senior Nurse, with a professional portfolio of practical and managerial experience and qualification, including the Registered Managers Award. She is ably supported by well-qualified, experienced Clinical Managers, senior nursing and care staff, who, in all represent an effective care management team. The Registered Providers, through the offices of an Area Manager, have demonstrated a high profile and involvement in the smooth running of the Home, Care Homes for Older People Page 26 of 32 Evidence: and are prepared to delegate a wide range of management responsibility to good effect. We were accompanied for the inspection, and the report feedback session by the newly appointed Area Manager, who contributed effectively to the inspection. We recognise the efforts made to enhance the Keyworker and Named Nurse team concept, and establishing Dignity Champions, that is, staff who have been trained to identify and promote issues of care that protect and enhance the dignity of people receiving care. We also recognise the Homes participation in PEARL accreditation (Positively Enhancing And enriching Residents Lives). We acknowledge the openness and confidence in the observed interactions of staff, relatives and people using the service. The relationships were seen to be of mutual trust and respect. Several comments made by people who live in the Home, and visitors we spoke with, reinforced the strong foundation of confidence they had in the management of the Home: They do everything well, a lovely home, staff very helpful. Its good at Park Farm Lodge, they treat the residents as individuals, and it seems that everyone who works here knows the residents by name, and as a person. I think it isnt just a building, its a home for a lot of people. The manager is always approachable and friendly to residents, staff and relatives. Staff selection is good mix of race and abilities, a very stimulating place to work. I am very happy with everything the Home does to care for my mother. I have no worries or complaints. Our examination of records showed appropriate risk assessments are in place for people, through care planning and recording, staff selection and maintenance and organization of the general environment. The services completed AQAA states that the home has quality monitoring systems in place, and they also consult the people who use the service and their relatives about the service. However we did receive a comment from a relative indicating: Each year Four Seasons issue a resident and relative survey, which I complete. Despite assurances each year I have yet to receive details of the findings of this survey and the changes that will be made as a result. Am I wasting my time completing these surveys? I raise similar points and suggestions in each survey. We, however found, through inspection, that there is a forum for managers to meet with relatives on a frequent basis, and we examined a quality assurance report, and Care Homes for Older People Page 27 of 32 Evidence: found it an accurate reflection of a commitment on behalf of the Provider to maintain and improve facilities at Park Farm Lodge. An examination of administrative, monitoring, planning and care records showed an organised and professional attitude to effective record keeping. Random samples of records showed that they were well maintained, accurate and up to date, ensuring that the peoples rights and best interests are safeguarded. We identified that people are encouraged to be independent with regard to financial affairs with the assistance of their relatives. We saw that small amounts of cash were efficiently handled by the administrative officer, through the Providers office, although essentially the home operates a cashless society. We made a random sample examination of the procedures manual, and found it to offer a very comprehensive reference. Policies on Missing Person, Safeguarding and managing abuse and confidentiality were examined, and found to be accurate and informative. Equality and diversity issues were also discussed covering a wide range of issues, including food, religion and staffing. We found that the health and safety of people who use the service and staff, are promoted with safe storage of hazardous substances, regular electrical PAT, servicing of hoists, gas appliances and regulation of the water system. The accident book was seen and found to be in order for staff and people using the service, with a three monthly analysis of trends and frequency undertaken by the manager. We traced the records of several accidents to identify that the appropriate level of action was taken, and that care plans were reviewed accordingly. Records were available to demonstrate an on-going process of regular supervision and supervised practice, showing training sessions and appraisals to be a routine feature of staff development. We found the administration and management of the home is efficient and sensitive to the needs of people living in the home. Care Homes for Older People Page 28 of 32 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 29 of 32 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 1 We consider that the Service User Guide presented in an audio and pictorial version would help people who have difficulty reading small print. We recommend that the process of tracking the disposal arrangements requires a review to complete the secure audit trail. The Registered Provider shall undertake a review of the standards of bedroom accommodation in several rooms that are poorly presented for care. The Registered Provider should review the use of information and instruction notices on display in bedrooms, which need to be placed more discretely. The Registered Provider shall review the use of communal stocks of items of clothing and ensure that each person who needs a movement and handling sling is issued with their individual slings. That the Registered Provider meet the expected need of people receiving nursing care on night duty by increasing the coverage to three Registered Nurses per night. 2 9 3 24 4 24 5 26 6 27 Care Homes for Older People Page 30 of 32 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 7 30 The Care Manager was advised to seek full training and procedural guidance on the Mental Capacity Act and Deprivation of Liberties for all senior staff. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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