Care Home: Peregrine House

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What the care home does well This home provides an excellent level of care in a homely and comfortable setting. Care is based on a thorough knowledge of each person, excellent assessments and plans of care which are regularly reviewed. Good risk assessments help people to be as independent as possible. People are assisted with their health care in a caring and friendly manner, and medicines are safely handled. Complaints are quickly dealt with and people are protected from harm by well trained staff. The home is clean and well maintained. There is an excellent ratio of staff to people, and staff are well recruited. The home consults people about practice and makes sure suggestions are acted upon. People made very positive comments about Peregrine House, some examples are: `They look after me brilliantly. The manager is wonderful. She doesn`t say a bad word about anybody and she`s always listening to what we want.` `We get good entertainments. We go out alot in the summer and in the winter we have been doing lots of interesting crafts.` A GP said: The people here get very good care.` What has improved since the last inspection? The home is continually striving to improve the standards of care. Since the last inspection the staff are better trained to offer good care to those people who may have a dementia. Staff also have better person centred care plans so that they can offer individualised care. The dining arrangements have been changed and then altered again following expert advice to improve the dignity and quality of life for all those living at the home. The management arrangements of the home have improved, with a head of care on duty 24 hours a day. People living at the home said that their lives had improved following the introduction of a special day for each person every month. This means that the named person chooses to do something on `their day` and staff are available to help make this happen if at all possible. What the care home could do better: This inspection has generated no requirements or recommendations. The manager of the home is good at recognising where improvements need to be made and the quality assurance system supports this process. Key inspection report Care homes for older people Name: Address: Peregrine House 48/52 Upgang Lane Whitby North Yorkshire YO21 3HZ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Karen Ritson     Date: 0 2 1 2 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 24 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 24 Information about the care home Name of care home: Address: Peregrine House 48/52 Upgang Lane Whitby North Yorkshire YO21 3HZ 01947603886 01947606663 peregrinehouse@yahoo.co.uk www.peregrinehouse.co.uk Aikmo Medical Limited care home 27 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): 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 Additional conditions: Service users in the category (DE) only if the predominant care need is due to a mild or moderate dementia in accordance with the homes` statement of purpose. The category (DE) refers to service users over the age of 60. Date of last inspection Brief description of the care home Peregrine House provides long-term accommodation and personal care for a maximum of twenty-seven older people. The home provides a specialist service to people with dementia who are cared for alongside other residents. If capacity permits people may be admitted on a short-term or respite care basis. The home is in a residential area of Whitby and is conveniently located for all main community facilities. It does not have its own parking facilities but ample on-road parking is readily available. It is a traditional building constructed during the late Victorian period. It was originally three properties that have been converted into one. Care Homes for Older People Page 4 of 24 Over 65 10 27 3 0 Brief description of the care home Peregrine House is built on three floors with service users accommodation on each floor. The main communal areas, such as the dining room, are located on the ground floor. Peregrine House has a number of small lounge areas situated on the upper floors thereby giving the service users a choice of communal space. The home has twentythree single and two shared or double bedrooms, all of which have en suite facilities consisting of a toilet and a wash hand basin. There is a passenger lift to all floors suitable for a wheelchair user and their helper. The home has large lawned gardens that have areas of seating for service users. Several windbreaks have been built in the garden so that people can sit in comfort and privacy with some raised planting areas. Ramps with handrails lead to all the main entrance doors. Information is given to new and existing service users to the home detailing the accommodation, facilities and services provided. The weekly fee is quoted by the registered manager as between £344.45 and £585.00 per week in December 2009. Additional charges not covered by the fee are hairdressing, private chiropody, newspapers at cost price, and bus outings at a subsidised cost. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection for this service took twelve hours. This includes time spent gathering information and examining documentation before and after a site visit and in writing the report. The home was visited on two days because on the first date, due to snowy weather conditions, the cook had not been able to attend for work and the head of care was needed to cook for the day. The manager was not on duty. A return visit was made the following day. The site visit took place on 1st December between 10:00 and 10:15 then on 2nd December between 09:30 and 15:00. Information for this inspection was gathered from the following: A tour of the premises, observations of care throughout the day of the site visit, speaking with people, case tracking people on the day of the site visit, examining policies, procedures and records kept at the home, examining information regarding the home on the file kept by CQC, considering comments made by relatives, health care and social services staff. We have reviewed our practice when making requirements, to improve national Care Homes for Older People Page 6 of 24 consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations -but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. All key standards were looked at during this inspection. The manager was available throughout the day of the site visit. Care Homes for Older People Page 7 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 24 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 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their care needs well assessed. Evidence: People have the opportunity to visit the service before deciding about admission. The manager arranges for a trial stay if possible. This ensures that any new placement is suitable for the person concerned and that the needs of people already living at the home are respected. The assessment takes place over a period of time so that care needs are well understood. Assessments cover all required areas. Documentation is clear, focused and concentrated upon individual needs. Health care professionals are also consulted wherever necessary, to ensure peoples medical and specialist needs are considered. Three assessments were examined. These clearly showed that people had been heavily involved in their own assessments and included life stories and aspects of each persons life which were considered of particular importance, this included examples such as past occupations, family details, likes, dislikes, hobbies and interests. This Care Homes for Older People Page 10 of 24 Evidence: means that people are considered holistically and that staff have enough information to understand needs and preferences well. Care Homes for Older People Page 11 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their health and care needs well met. They are protected by the safe handling of medication. Evidence: A care plan for each person is drawn up, based on the assessment. All specialist requirements are included in this plan, including medical and health needs and any specific needs arising from dementia. This ensures that peoples needs are considered holistically and that these needs may be met. All care plans are reviewed monthly by keyworkers with the person involved where possible The review is in depth and covers each area of the care plan. This ensures that the home is responsive to the changing care needs of those living there. Three care plans were examined and these contained detailed information on care needs and how these would be met. The key principle of the home is that people using the service are as in control of their lives as possible and that their needs direct the service. Staff were fully committed to supporting individuals to lead purposeful and fulfilling lives as independently as possible whether or not they have a dementia. One health care professional said: Staff are very professional and always speak kindly to residents, they help people to their rooms for Care Homes for Older People Page 12 of 24 Evidence: treatment and always call on us appropriately. A visiting GP said: The people here receive very good care. The staff know about the medication people are prescribed and call us if they are concerned about anyones health. Staff are very attentive and concerned for each person. Risk assessments are in place, and the home emphasises independence. People are not discouraged from doing what they choose if there is an acceptable level of risk involved. Relatives and health care professionals reported that the people living at the home are continually consulted about their lives at Peregrine House. One relative said: She can do what she wants when she wants. She lives her life the way she wants to. Each person has their medication individually in each room. Medication is well administered, with good records. The manager is reminded to always carry forward total quantities of packeted medication onto record sheets so that a running total of medication may be kept. This was not the case on one recording sheet examined. All staff have received safe handling of medication training to make sure those living at the home are protected from unsafe medication practice. Throughout the day of inspection staff were observed taking an exceptional level of care and consideration in their duties with people. Privacy and dignity were well respected. Feedback from people living at the home and from visitors confirmed that the staff treat each individual with great respect. This means people experience being valued and respected as individuals. Care Homes for Older People Page 13 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well supported to live the lives they choose. Visitors are made very welcome and people benefit from an excellent varied diet. Evidence: People are encouraged to live a full and interesting life at Peregrine House according to individual preferences. Each person gets up and goes to bed when they choose. One person said: A few of us have had a go at mosaic trays and are really proud of what weve done. Weve also planted bulbs and are waiting for the shoots to come through. Each person living at the home had been given a personalised brochure of the entertainments and events during the month of December, menus for the festive days were also included so that people could look forward to what was on offer and plan their days around what they preferred to do. The home employs regular professional entertainers and craft classes are available on three afternoons a week. Each month, every person living at the home has the opportunity to choose whatever they wish to do on that day. One person had chosen to visit a relative for the day accompanied by a member of staff. Another person had gone into town with a member of staff to buy clothes. Each week, in the warmer months, the home puts on a coach trip to local places of interest. People choose where Care Homes for Older People Page 14 of 24 Evidence: they wish to go in the residents meetings. One person said: We are always booked into somewhere lovely for afternoon tea on our trips, and we only pay a fraction of what is really costs. We are really treated well. Another person said: They always make a big fuss of us a birthday times, we have a cake, a beautiful bouquet of flowers and we have sherry or wine at tea time. The social and leisure needs of people with a dementia are well understood by staff. The manager is promoting the idea of short meaningful interventions with people whose concentration span can be limited. Throughout the day of the inspection staff were observed speaking kindly with all people, including those with memory problems. One person with a memory impairment was clearly enjoying this friendly banter and was smiling. People living at the home clearly knew the staff and each other well, and there was an atmosphere of inclusion and belonging. Another person said she felt much better now she had moved from a different home. People talk to me here. Its lovely. A relative was spoken to who regularly visit the home. She said she was made to feel very welcome. One person living at the home said: Family are always welcome. There are some dates set aside running up to Christmas when families are invitied to join with us for a Christmas lunch. The home has a varied and nutritionally balanced menu. Meal times are a highlight of the day and people said they always enjoyed the food and that there was plenty of choice. On the day of inspection the meal was of a very high quality. The home caters for specialist diets as required. This ensures people get the diet they need and enjoy. Most people choose to have meals together, but those who prefer can eat in another lounge or their rooms. Peoples likes and dislikes are well known and if there is something a person does not particularly like on the menu, the cook will always provide an alternative. One person said: The food is excellent and weve suggested lasagne and vegetarian meals too which have appeared on the menu. Anything you fancy they will do for you if it is at all possible. Another person said; My family cant believe the amount of food we get! Every meal is beautiful. This means that peoples individual preferences and requirements regarding food are taken into consideration. Care Homes for Older People Page 15 of 24 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 listened to and any complaints are addressed quickly. They are protected from risk of harm. Evidence: The home has a complaints policy and procedure. People living at the home said they were always encouraged to say if they were unhappy about any aspect of their care. One person said: There were some things not right when I first arrived and I thought about leaving, but they said if I told them what was wrong they could put it right and they have, so I decided to stay. Visitors and health care professionals all reported that the home was very responsive to comments and always strove to provide the highest level of care. This ensures that the home works well with people to provide a good service and shows that it has an open culture where individuals feel safe and supported to share any concerns in relation to their protection and safety. Staff have all received abuse awareness training, either directly or through NVQ training and those spoken to had a clear understanding of vulnerable adults policy and procedure. All accidents and incidents were recorded with outcomes, so that the home could track the vulnerability of people in its care and put safeguards in place. Risk assessments were focused on individual needs and gave detailed instructions for care. This means that people living at the home are protected from harm and risk of abuse. Care Homes for Older People Page 16 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well maintained environment. Evidence: The home is well decorated, furnished and provides a very pleasant environment for people to live in. People with memory problems are assisted to have breakfast in a small homely dining area where staff can provide good support for them to eat. The home is very clean and fresh smelling throughout. A member of domestic staff said: The owner has very high standards and I understand why. It makes it a pleasure to work here. Decor is updated on a rolling programme and some work has been carried out since the last inspection. The garden has been improved with the creation of raised planting beds for people living at the home to use. The laundry is located outside of the main home and people commented that their clothes were always well laundered and there were no problems with items going missing. The home has its own fire risk assessment and meets the requirements of the local fire authority and the environmental health department. Care Homes for Older People Page 17 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a home which is run with sufficient staff, who are well trained and recruited. Evidence: The home has very good staffing levels with staffing ratios exceeding the minimum required to keep people safe. The emphasis is upon providing sufficient staffing to allow people to have a high quality of life at Peregrine House. A head of care is available every day, seven days a week. This means there is always a person to go to for advice or assistance. Two members of staff were recently shortlisted for the Great North Care Awards. They had been nominated by people using the service. Staff are all recruited suitably, with required checks in place and references sought. This means that the home recruits staff in a way which protects the welfare of people living at the home. Staff have all had induction training which is well recorded. They have also received foundation training on a rolling programme. An assessor for the National Vocational Qualification said that staff at the home were keen to complete their training and that they were always willing to learn. She said.This is just a lovely place. its the number Care Homes for Older People Page 18 of 24 Evidence: one place I would want a relative of mine to be if they needed care. This means staff have the necessary skills to offer good care. Most staff had also completed dementia awareness training to better understand the needs of some of the people living at the home. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from excellent management of the service. Evidence: The manager has NVQ level 4 in care and management. Throughout the inspection she demonstrated a clear vision of the home based on its values and priorities. She constantly confirmed that the people living at the home were central to the homes purpose and that the ultimate aim was to care for and nurture each person as an individual. The manager communicated this clear sense of direction to her staff and continually evidenced a sound understanding and application of best practice, particularly in relation to peoples quality of life and happiness. Equality and diversity, human rights and person centred thinking are given priority. The manager and staff demonstrated this throughout the day in numerous conversations with people living at the home and further evidence was available in care plans and daily records, from staff and from visitors to the home. This means people live in an excellently managed home. One person who lives at the home said: They look after me brilliantly. The Care Homes for Older People Page 20 of 24 Evidence: atmosphere comes from the top. All the new staff pick up the vibes and seem to understand that they are in a really good home and the best is expected. Teresa the owner is a wonderful, kind person and Alison and Olwyn are marvellous. In fact, they all are. The manager operates a quality assurance system, where people are consulted about the quality of their care on a regular informal basis and more formally when care plans are reviewed. All written feedback received is kept on file and comments are taken into consideration when planning improvements. Many people commented that the manager encouraged feedback and was excellent at listening to people and putting suggestions into practice. The home is concentrating upon workimg towards an Investors in People Award and for the past two years when there was no CQC Key Inspection of the home the management have commissioned external auditors to ensure that standards continue to be maintained and improved. People are kept safe by the policies, procedures, safe working practices, risk assessments, staff training and regular maintenance of systems and equipment in the home. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 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 9 It is recommended that running totals of packeted medication should be kept so that accurate audits can be made. This would minimise the rsk of medication error. Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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