Care Home: Patchett Lodge

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What the care home does well The home provides a pleasant, homely and clean environment for people who live there. People gave positive comments about their care and praised staff for the way they delivered care. Their comments included, the `staff are very good` and `marvellous`. The activities organiser provides a varied programme of stimulation that people said they enjoyed. They told us they joined in activities of their choice and said they enjoyed going out in the mini-bus owned by the home. Leadership in the home is good and quality assurance systems are in place to ensure the home is run in the best interest of people living there. What has improved since the last inspection? The organisation has addressed the previous requirement to repair or renew torn and scuffed wallpaper in the corridors and improvements have also been made by refurbishing some bedrooms, repainting some external areas, tarmacing the grounds outside of the kitchen and an extension to the conservatory. The Statement of Purpose and Resident Guide have been updated and include a copy of our report and information about the current fee rates. What the care home could do better: Care plans could be improved further by including the action staff need to take to show that the mental capacity of people has been considered. They should also clearly give staff guidance regarding the action they should take to meet specific needs, for example, using a `pain relieving machine`. The organisation should ensure all staff receive regular updates to training in relation to safeguarding adults and all staff should have regular supervision. Re-decoration should be carried out in ground floor bathrooms and toilets to make them look less institutional. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Patchett Lodge Stukeley Road Holbeach Lincs PE12 7LJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elisabeth Pinder     Date: 0 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Patchett Lodge Stukeley Road Holbeach Lincs PE12 7LJ 01406422012 01406490621 manager.patchett@osjctlincs.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Susan Gardner Type of registration: Number of places registered: The Orders Of St John Care Trust care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The home is registered to provide personal care for service users of both sexes whose primary needs fall within the following category:- Old age, not falling within any other category (OP) - 30 The maximum number of service users to be accommodated is 30 Date of last inspection Brief description of the care home Patchett Lodge is one of sixteen care homes owned and operated by the Orders of St John Care Trust, a registered charity. It is a purpose built two-storey building, formerly a local authority home, and is registered to provide care for up to thirty older people. On the day of the inspection 22 were being accommodated. The home is situated in its own grounds in a quiet residential area for older people in the market town of Holbeach, which has a variety of services and facilities. The home provides its own transport for residents in the form of a mini-bus. Weekly fees range from £397 - £494, additional charges are made for hairdressing, chiropody, newspapers and personal Care Homes for Older People Page 4 of 26 Over 65 30 0 Brief description of the care home toiletries. A nominal charge of 40 pence per mile is made for hospital appointments if the homes mini-bus is used. Information about these costs, as well as the day-to-day operation of the home, including a copy of the last inspection report, is available in the reception area or from the office. Accommodation is provided on two floors, which are accessible via a lift or stairs. In addition the home provides a day care service on the first floor for up to ten persons from Monday to Friday. The day service is not regulated by the Commission for Social Care Inspection and therefore did not form part of this inspection. Residents can use the day care facilities during evenings and at weekends. People who attend for day care also use the same dining facilities as residents. 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: This was an unannounced visit and it formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of people who use the service. Throughout this report the terms we and us refer to The Commission for Social Care Inspection (CSCI). The visit lasted just over five hours and we took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last visit. Before we made our visit the manager had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans to improve aspects of the service. We sent out surveys to people before we visited the service and these are mentioned Care Homes for Older People Page 6 of 26 throughout the report. The main method used to carry out the inspection is called case tracking, this includes following the care of a sample of people through their care records and assessing their care. We spoke to people who use the service and saw rooms of those who said we could and to two staff members. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People coming into this service have access to a range of information to help them make a decision about moving into the home and procedures are in place to ensure people are only admitted after a full needs assessment has been carried out. Evidence: Information sent to us prior to the inspection told us that people have access to a range of information about the service and this was confirmed during our visit. The Statement of Purpose and Residents Guide have recently been updated and included a copy of our last report and information about the current fee rates. They also inform people how differing needs, such as religion and culture will be met and how the service considers the Mental Capacity Act. The manager told us that both documents can be produced in different formats if needed and agreed to provide an audio version for one person recently admitted who is blind. People living in the home also receive a copy of the Trust magazine. Care Homes for Older People Page 10 of 26 Evidence: Care records of two people who had recently been admitted were looked at and these showed that a needs assessment had been carried out prior to their admission. However, records indicated that one person had been diagnosed with Alzheimers and this was discussed with the manager as the service is not registered for Dementia and we were told that their primary needs on admission could be met under the homes current registration. The manager showed us how they were ensuring the persons primary needs could be met through her own assessment and a further assessment is being provided by other professionals to support the manager and person with identifying and meeting needs in the right way. People are written to by the manager after their assessment confirming that they can or cannot meet their needs. Two surveys returned to us before the visit told us people had received enough information about the home before moving in, one identified that they had been given a contract of residency, one had not. However, records for this person were looked at and showed that a contract was on file. During the visit people told us they were happy with the home and the services offered, one person said they had only come into the home while waiting for a place elsewhere but they were so satisfied they decided to stay. Another person told us they knew the home well as they had attended the day centre and its marvellous. The service does not cater for people with intermediate care needs, however up to ten people do come to the home for day care Monday to Friday. 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. Peoples personal care and health care needs are being met by staff who understand their needs and have access to adequate information written in care plans. Medication policies are detailed and safe procedures are being followed for the administration, recording and storage of medicines. Evidence: Three peoples records were looked at and these generally gave clear information to enable staff to know about their individual needs and how to meet them. However, the care plan for one person who had a pain relieving machine to help with pain control in the night did not provide staff with guidance about where to place the pads or the length of time the machine could be on. The care plan for another person was in the process of being completed as they had only been in the home for approximately one week. We saw that care plans have been revised to ensure they are more person centred and have been written as if the person had completed them themselves. However, they do Care Homes for Older People Page 12 of 26 Evidence: not tell us whether the person has written these or the level of their involvement and this was discussed with the manager who agreed to address this. Care records included medical profiles, life histories including hobbies and interests, individual likes and dislikes, detailed risk assessments, personal preferences and appointments with healthcare professionals. Various assessments have been completed on subjects such as, manual handling, pressure risk and nutrition. Care plans had been reviewed at least once a month and daily notes written to show that people receive the correct level of care and support. One person told us she was unaware of her care plan but records showed that she had been involved in a six monthly review. However, some monthly evaluations read no change and did not show that people have been given the opportunity to be involved in the evaluation. Care records looked at did not make reference to whether peoples capacity to make decisions had been considered when drawing up care plans and this is important in view of legislation which came into force in October 2007. Staff told us they had received some training regarding the Mental Capacity Act and were due additional training in January this year. Information taken from the AQAA told us that policies and procedures concerning the receipt, storage, administration and disposal of medications were available. We looked at medication records of the people whose care was being followed and observed medications being administered at lunchtime, these showed that the people were receiving their medications correctly. People were happy with the level of support given and told us they felt their needs were being met. Staff spoken to had a good knowledge of the needs of people who use the service and were observed to be responsive to needs and were respectful and kind. 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 are able to take part in various recreational activities and maintain contact with family and friends as they wish. Meals provided are well balanced and take into account personal preferences and special dietary requirements. Evidence: Information sent to us prior to the visit indicated that a range of activities are provided to meet individual needs. An activity co-ordinator commenced employment two months ago and works 20 hours each week. During the visit this person was on leave and no activities were observed. However, people told us they join in activities of their choice, one person said they enjoyed going out in the mini-bus owned by the home and had enjoyed a recent Christmas carol service. Another person said they where unable to take part in some of the activities but really enjoyed the interaction of quizzes. Peoples beliefs and preferences are recorded and arrangements are made to meet those needs. A monthly church service is held in the home and care records showed which people liked to attend. Although activities are not currently being written on individual records the manager told us that this is to become part of the tasks designated for the activity co-ordinator. People said they were able to keep in touch with family and friends and have visitors whenever they choose and this was Care Homes for Older People Page 14 of 26 Evidence: evident throughout our visit. Meals are served in the dining room and we saw people chatting with each other as they ate. They told us that the menus were varied and a choice offered. Alternatives and specialist diets, such as a diabetic diet were also available. Tables were nicely laid with placemats/napkins and condiments and the meal of the day was chicken casserole or sausage pie with seasonal vegetables, this looked appetising and people told us they had enjoyed it. The results of a recent quality assurance audit showed us that meals had been altered to suit peoples choice and we spoke to approximately six people in the dining room who confirmed this and told us they were happy with the food on the menu. One person said the food is unbelievably good. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the procedures in place for handling complaints and are confident that their complaints or concerns will be taken seriously. Staff must be kept up to date with changes to how allegations of abuse are reported to ensure people are protected. Evidence: Information taken from the AQAA told us that a clear complaints procedure is displayed on the wall and included in the residents guide and this was confirmed during our visit. People told us they felt able to raise issues with their relatives, key worker, care leader or manager and felt these would be taken seriously. Surveys received prior to the visit all indicated people know how to make a complaint and who to speak to if they were unhappy. One specific comment read, I always speak to the manager, she is very good. Within the last twelve months one complaint had been received and records looked at showed that this had been dealt with appropriately and within the correct timescale. Head office monitors all complaints and there is a system in place to re investigate any issues that are not conclusively resolved at home level. No incidents of abuse have been reported to Lincolnshires safeguarding team within the last year and training records showed most staff had undertaken relevant training. Care Homes for Older People Page 16 of 26 Evidence: However, records for one member of staff on duty showed that training relating to safeguarding adults had not taken place since 2006 and whilst this person had a good understanding of the types of abuse they were unclear of the correct procedures to take to report any incidents but said they always had access to a home manager within the organisation and this was confirmed by the manager. The manager also told us she would ensure this member of staff has an update in these procedures. Care Homes for Older People Page 17 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. People living in this home live in a clean, comfortable and homely environment. Evidence: We took a partial tour of the home which included looking at the bedrooms of the people whose care was being followed and some communal areas. Bedrooms had been personalised by the person or their families with photographs, mementos and small items of furniture. There were no unpleasant odours detected in the home. Two surveys completed by people living in the home told us that the home is always fresh and clean and one comment read everywhere is very clean. Since the previous inspection a requirement to repair or renew torn and scuffed wallpaper in the corridors has been addressed and improvements have also included; some bedrooms being refurbished, external paintwork and tarmac to grounds outside of the kitchen and an extension to the conservatory. A recommendation made during the last inspection regarding bathrooms and toilets being decorated to look less institutional had not been addressed and the manager said this work had been put forward for this years budget. Staff told us protective aprons and gloves are always available to use when needed and various pieces of equipment were in use during the visit including hoists, specialist mattresses, raised toilet seats and grab rails. Care Homes for Older People Page 18 of 26 Evidence: The service has received a 3 tulip award which is an excellent for food safety from South Holland district council Environmental Health. Their report dated 06/11/08 read good standards of structure and cleanliness. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is enough staff on duty to meet the needs of the people currently living at the home. People are protected by robust staff recruitment procedures and staff have access to training and support to ensure staff are knowledgeable and equipped to meet the needs of people living here. Evidence: On the day of the visit 22 people were living at the home, 2 of whom were in hospital. Duty rotas looked at for the past four weeks showed that there were generally three care staff in the morning, two in the afternoon and two throughout the night. In addition to this there is care leader, registered manager and administrator on duty. Surveys received prior to the visit told us that staff are always or usually available when needed and comments written read, more staff would be a great help and Im very pleased with the way they care for my husband. During our visit only positive comments were received from people, these included staff are very good, marvellous and staff are good, they know how I like things to be done. People whose care was being followed told us they felt there was enough staff on duty and if they have to call them they never have to wait long before someone comes. The records of two staff recently employed were looked at and these showed that staff were being recruited safely with essential checks such as written references and C.R.B. Care Homes for Older People Page 20 of 26 Evidence: (Criminal Records Bureau) checks being undertaken. Information received told us that 50 of care staff have achieved a nationally recognised vocational award, level II in care and 75 of care leaders have achieved level III. The service is now using E-Learning training for induction and medication training. Two members of staff spoken to confirmed they had received training including induction, moving and handling, health and safety and fire. Awareness of the Mental Capacity Act training had been provided using a computer and staff spoken with confirmed they are to receive further training in January. Observation of care practises during the visit showed staff caring for people in an appropriate manner. They were visible in communal areas and responded well to peoples needs. Care Homes for Older People Page 21 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. This home is well managed and the staff are generally supported and supervised in carrying out their roles. The audit and policy systems ensure that peoples views are listened to and acted upon. Evidence: The registered manager is suitably qualified and experienced to run this home. She is a qualified nurse and has completed the Registered Managers Award. She has over ten years experience in management of care homes and has been managing this service for approximately five years. Surveys received prior to the visit raised no concerns regarding the current management arrangements. Discussion and records showed that there are various systems in place to monitor the quality of the service being provided. This includes seeking the views of people through meetings and questionnaires. Minutes of the last meetings for people living in the home and staff were looked at and these showed that various topics were discussed including Organisational issues, staffing, menus, activities events and training. The service has attained a Quality Care Homes for Older People Page 22 of 26 Evidence: Award and Investors in People Award by independent companies who audit the homes systems against expected standards. The home also carries out quality monitoring questionnaires and the results of these carried out in July 2008 were looked at together with the action taken to address any issues raised. Information provided in the AQAA told us that there are a range of policies and procedures in place and the majority of these had been reviewed and updated in 2008. We were also told of equipment maintenance and service dates. Building risk assessments are in place and regular health and safety audits are completed. There are satisfactory arrangements in place to ensure any valuables or monies held on behalf of people living in the home are kept safe and we looked at records held for the people whose care was being followed and these were all up to date and accurate. Generally records required by law to be kept about the operation of the service were up-to-date and well maintained. Someone from the Company had visited the home at least once a month and completed a report on their findings which included talking to people living at the home and to staff. Care Homes for Older People Page 23 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 24 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 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 7 Care plans should clearly state the action staff must take to ensure they show that consideration to the Mental Capacity Act has been given. All care plans should give staff clear information to enable them to know about individual needs and how to meet them. All staff should have regular training in relation to safeguarding adults to ensure they know the up to date procedures including the reporting processes. Bathrooms and toilets should be decorated to look less institutional where possible. All staff, including relief staff, should receive regular supervision to ensure they have the opportunity to discuss their performance, care practises and any issues arising. 2 7 3 18 4 5 19 36 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!