Care Home: Philiphaugh

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What the care home does well The staff at Philphaugh were providing personal care and support for 25 people on the day of the inspection. Staff were observed working with people in a positive manner which resulted in individualised care and support. Pre admission assessments are always carried out to ensure that the home can manage the needs of the person. The new care plans have detailed information about the residents needs. A transfer to hospital form is included in the care plan with information on it already to give to the emergency services or GP promptly if somebody needs to go to hospital. Ongoing training means that staff are up to date with statutory training and have the skills to look after the people in their care. Documentation and records seen were well organised, up to date and stored as required. People are given choices about how they spend their time. There are in house and outside activities available and people retain links with the local community. We were told that people enjoy the meals at the home and that there is always a choice. What has improved since the last inspection? All but one of the requirements made at the last inspection have been met. A lot of effort has been made and is ongoing to make sure the environment meets the needs of the current residents. Documentation and policies and procedures have been updated to reflect current good practice and laid down legislation. All of the recommendations made following the last inspection have been met. What the care home could do better: Two requirements have been made following this inspection. The fire alarm must be tested on a weekly basis and the test recoded in the fire log book. The up to date policy regarding the Safeguarding of Vulnerable Adults must be made available to all staff so that they are aware of the local reporting procedures. It is recommended that all prescribed dietary supplements should be signed for on the medication administration record and staff should ensure that prescribed creams or lotions used on the named individual in a bathroom are taken back to the persons room once they have vacated the bathroom to avoid possible communal use of creams. It is recommended that the complaints procedure should include the address of the local Department of Adult Care and Support as they are the first point of contact should a complaint or concern bought to the attention of the registered manager or the registered provider not be resolved. None of the complaints procedure should be obscured by stickers on the glass in which the procedure is displayed. Key inspection report Care homes for older people Name: Address: Philiphaugh Station Road St Columb Major Cornwall TR9 6BX     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: Mandy Norton     Date: 2 1 0 6 2 0 1 0 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 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Philiphaugh Station Road St Columb Major Cornwall TR9 6BX 01637880520 01637880520 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Stephen Michael Hendy Name of registered manager (if applicable) Mrs Alice Margaret Taylor Type of registration: Number of places registered: care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Service users to include up to 12 adults of old age (OP) Service users to include up to 19 adults aged over 65 with a mental illness (MD(E)) Service users to include up to 19 adults aged over 65 with dementia (DE(E)) Service users to include up to 6 adults aged over 65 with a learning disability (LD(E)) Total number of service users not to exceed a maximum of 32 Date of last inspection 0 6 0 7 2 0 0 9 0 0 0 0 Over 65 19 6 19 12 Care Homes for Older People Page 4 of 27 Brief description of the care home Philiphaugh provides care for up to thirty two people in need of care by reason of old age, dementia, mental disorder and a learning disability. Respite care is available at the home in addition to long stay care (when a bed is available). The home also provides a day care service. The home is situated close to the town of St Columb Major enabling the more mobile people to visit the shops and facilities independently. The home is set in attractive grounds and is a listed building. Car parking is available in the grounds of the home. The building has been extended with two wings. There are several communal rooms including an activities room and a smoking lounge. Access to the first floor in the main house is by a staircase, which is provided with a stair lift. Bedrooms are available on the ground and first floor of the home. Many of the bedrooms have en suite facilities. The current fee range is available from the manager and does not include chiropody, hairdressing, newspapers and some toiletries. The Department of Adult Care and Support will carry out an individual financial assessment , if they are funding the placement. Care Homes for Older People Page 5 of 27 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 unannounced Key Inspection took place from 10.20 am until 2.20pm on 21st June 2010. It was conducted with the deputy manager. A tour of the home was carried out and residents and staff were observed and spoken to informally during this time. A variety of records were seen throughout the visit. Other evidence gathered since the previous inspection such as notifications received from the home and the annual quality assurance assessment (AQAA), submitted prior to the inspection, were also used to help form the judgements made in the report. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 7 of 27 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 27 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 27 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 current pre admission assessment in use means that peoples diverse needs are identified and planned for before they move to the home and the home are sure that they can meet the persons needs. Staff have or are undergoing training specific to the needs of the people who currently live at the home which means peoples diverse needs are generally being met. Evidence: The deputy manager said that people are always assessed prior to moving into the home, by the manager or herself to ensure their needs can be met. The home has in place a Service User Guide and Statement of Purpose to enable prospective residents and their relatives/representatives to make an informed decision about the home. Care Homes for Older People Page 10 of 27 Evidence: The training records showed and the deputy manager said that training specific to the residents assessed needs such as dementia and palliative care has been completed by a number of staff , since the last inspection, and more are booked to undertake the courses in the near future. Care Homes for Older People Page 11 of 27 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 practice regarding the planning and delivery of care means that people can be sure that their health, personal and social care needs will generally be met. Evidence: The deputy manager showed that care plans are now in place for everybody. They are reviewed monthly along with the individual risk assessments. Four were examined during the inspection and they included most of the required information and detailed information about a persons daily welfare. The deputy manager also said that they are starting life history books for each person so that the care and support they receive can be more individually tailored to suit their needs and likes. The home also has a completed hospital medical form (transfer sheet) in each care plan, that details important information that can be used if somebody needs to go to hospital and can be given to the paramedics or GP as required. This was noted as good practice. The care plans are stored securely in the dining room and are accessible to all staff at all times. A tour of the home showed that equipment for prevention of pressure sores is available. The deputy manager said that people have access to their own GP, the home has a good working relationship with the local community nursing service, have Care Homes for Older People Page 12 of 27 Evidence: access to CPNs, a dementia care nurse to assess people, the community mental health team (& out of hours contact) and Serco doc. out of hours GP service. The deputy manager and training records seen show that all staff who dispense medication have appropriate training. There is a clear medication policy which is signed by staff, this was last updated in May 2010. The medication records seen were well maintained. A tour of the home showed that a large tub of cream was in the communal bathroom, with no label or date of opening, suggesting that it may be used communally. The deputy manager made sure it was disposed of during the inspection, she will remind staff to only use creams labeled for an individual person and take it back to their room when they have finished in the bathroom. The dental tablets are now locked away in a cupboard in the bathroom and although they should all be individually labeled with peoples names only 3 out of the 6 seen were. The medication administration record (MAR) sheets examined have creams and lotions signed for against the times they were applied, the deputy manager said they do not sign the MAR for prescribed supplementary drinks given but that they would now do so. At the time of the inspection nobody was self administering medication but the deputy manager said that if anybody wants to a risk assessment would be carried out to see if it would be safe practice. During the insepction people were being treated with dignity and respect. The AQAA states that all staff treat Service Users with respect and know that they have a right of choice. Care Homes for Older People Page 13 of 27 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. A range of activities within the home and the local community mean that people have opportunities to participate in stimulating activities that meet their individual needs. Meals and mealtimes are not rushed and staff are available to help make them an enjoyable occasion for people. Evidence: The home have a mini bus used to take people out on local trips to beauty spots or shops (as appropriate). The deputy manager talked about a trip out that took place the week before the inspection that everybody who took part seemed to enjoy. A number of people go out regularly with relatives or friends. In order for people to have the opportunity to choose their own clothes a clothes party takes place in the home at least twice a year. The staff and some are residents currently preparing for the Summer fete to which the local community are invited and any money raised is put into the residents fund. Any in- house or outside activities taken part in are recorded in care plan or handover books. The deputy manager was advised to document who had been asked to take part in an activity but declined the offer for the purposes of internal audit. The daily menu is displayed within the home. Alternatives to the menu are always Care Homes for Older People Page 14 of 27 Evidence: available. The deputy manager showed us the menus holders that have been purchased to put on the tables at mealtimes, the menu has been developed and is waiting to be printed out and placed in the holders. Music is played during lunchtime, which people seem to enjoy. People have been asked about their likes and dislikes in terms of meals during recent quality assurance /satisfaction survey. The results have not yet been collated but evidence was seen that questionnaires have been returned. There are sufficient staff on duty at mealtimes who are able to lend discreet support and assistance as required. Care Homes for Older People Page 15 of 27 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. Formal complaints policies and procedures are in place and are available to staff at all times. All staff have had safeguarding training. The safeguarding policies and procedures have yet to be updated and made available to all staff. This means that people who live at the home are generally adequately safeguarded. Evidence: The complaints procedure is displayed in the entrance foyer but the address of the CQC is covered by a sticker on the outside of the display cabinet. The address of the local Department of Adult Care and Support (DACS) needs to be added to the procedure as they are the people to be contacted with a complaint if it cannot be dealt with by the registered provider or manager. The home or the Commission have not received any complaints since the last inspection. The deputy manager said that the updated safeguarding (SG) procedure has not yet been circulated to staff although the AQAA states that all staff have had SG training (via a distance learning package) and Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS) training. The deputy manager said that the registered manager or provider are always on call between them and would know the exact procedures should a SG alert need to be made. Care Homes for Older People Page 16 of 27 Evidence: The deputy manager said that all residents had been asked about voting for the recent general election. Most people who were able to say asked for a postal vote, which was arranged for them, and one person went to the local polling booth in person. Formal complaints policies and procedures are in place and are available to staff at all times, although it does need updating with the local Department of Adult Care and Support address. All staff have had safeguarding training. The safeguarding policies and procedures have yet to be updated and made available to all staff. This means that people who live at the home are generally adequately safeguarded. Care Homes for Older People Page 17 of 27 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. Ongoing refurbishment, redecoration and maintenance means that people have a homely and safe environment in which to live. This will continue to improve as the refurbishment ands redecoration is maintained. Evidence: A tour of the home showed that the environment, whilst homely and comfortable, is undergoing refurbishment and redecoration as an ongoing process. The grounds were tidy and well maintained and accessible to the current residents. Since the last inspection some of the windows on the first floor have been replaced and the walls and floors of the downstairs bathrooms have been repaired or replaced. All windows checked on the first floor were restricted appropriately. Freestanding furniture has also been risk assessed and as a result has been fixed to the walls. Wheelchairs seen in use in the home all had foot plates fitted. Individual rooms seen were personalised to reflect peoples own personalities. Most of peoples doors now have locks on them that can be overridden or they have been/are in the process of disabled /replaced for access if a resident needs urgent help. There is storage space available for wheelchairs and equipment and there is a call bell system throughout the home. The laundry has the appropriate equipment to manage the amount of laundry produced. The clean clothes are taken to the ironing room where they are sorted and put into individual boxes and then delivered to each room during Care Homes for Older People Page 18 of 27 Evidence: the day. The deputy manager said that the care staff have hand gel with them at all times and can wash their hands and dispose of aprons and gloves in the unused bathroom on the first floor. There are more hand washing facilities and bins available on the ground floor. Care Homes for Older People Page 19 of 27 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. The current staffing levels and skill mix are satisfactory meaning peoples needs are being met. The recruitment procedure in use means that people who live at the home are being looked after by appropriate staff and their welfare is not at risk. Evidence: The deputy manager felt that the current staffing levels meet the needs of the residents. The duty rota seen was easy to understand, included staff members full names and was dated. A cover sheet is used to show shifts that are not covered and staff (including bank staff) are asked to cover any shifts they can if this is not possible then the sheet shows where agency staff will be needed (the use of agency staff is not common). Domestic, catering and maintenance staff are employed to support the care staff. The AQAA states that 8 of the 15 full and part time care staff have achieved at least and NVQ in care to level 2. The staff file examined had all the required information included in it and was stored securely. The deputy manager said that any gaps in employment are explored at interview and information written on the back of the application form as evidence of this. There is a training record in place that shows when people are due for training Care Homes for Older People Page 20 of 27 Evidence: updates and the variety of training they undertake. The deputy manager said there are plenty of training opportunities and that supervision and appraisals are ongoing where individual training needs are discussed (evidence seen in the staff file examined). Care Homes for Older People Page 21 of 27 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. The systems and procedures in place are designed to meet the needs of the service as they strive to continually improve the service the home offers to the people that live there. The responsible attitude to health and safety shown by the provider, manager, care and ancillary staff means that people live in a safe environment. Evidence: The registered manager is qualified to and experienced in running the home. The deputy said they work well together as a staff team. The deputy manager said that resident surveys were sent out recently (to the resident or their representative) asking about their satisfaction with the service. A number have been returned (examples of which were seen during the inspection and included positive comments) and the results are in the process of being collated. The policies and procedures file was not looked at during the inspection but there is evidence that Care Homes for Older People Page 22 of 27 Evidence: the medication policy and safeguarding policy have been or are being updated. Residents money that is looked after by the home is securely stored , balances are checked regularly and signed to say they are correct, transactions are recorded and receipts kept as proof of purchase. The deputy manager said that formal supervision (one to one) meetings are carried out regularly as required and evidence of this was seen in the staff file examined. Training records show that statutory training, including fire safety and manual handling, is up to date is up to date. The fire log book had no entries to confirm a weekly fire alarm test is taking place. A requirement has been made to ensure that it is set off and recorded as such in future. The deputy manager said that the water temperatures are now checked monthly throughout the house and a report given to the manager. Individual risk assessments were seen in care plans examined and as a result of environmental risk assessments all free standing furniture has been secured to solid walls to prevent them accidentally falling on anybody. The deputy manager was able to show the inspector an ongoing induction for a new member of staff and explained the induction procedure in place. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 18 18 The registered manager is 21/08/2009 required to ensure that a clear policy on abuse awarness is available for staff. This policy must reflect the best practice local policy for Safeguarding Vulnerable Adults. This will ensure that all staff are aware of the correct actions to take should an allegation of abuse be made. Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 18 The registered manager is 01/08/2010 required to ensure that a clear policy on abuse (safeguarding) awareness is available for staff.This policy must reflect the local best practice guidelines for Safeguarding Vulnerable Adults. (This is repeat requirement.) This will ensure that all staff are aware of the correct actions to take should an allegation of abuse be made. 2 38 17 The fire alarm must be tested on a weekly basis. This test must be recorded in the fire log book. This is required to ensure the safety and wellbeing of people using the service. 01/08/2010 Care Homes for Older People Page 25 of 27 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 The registered manager should ensure that all of the dental tablets stored in the locked cupboard in the bathroom have individual peoples names on them. The registered manager should ensure that prescribed creams or lotions used on the named individual in a bathroom are taken back to the persons room once they have vacated the bathroom to avoid possible communal use of creams. The registered manager should ensure that all prescribed dietary supplements are signed for on the medicine administration record when they have been given to a Service User. The registered manager should ensure that the complaints procedure in the entrance foyer should be completely visible to people. The complaints procedure should also include the address of the local Department of Adult Care and Support as they are the first point of contact should a complaint or concern bought to the attention of the registered manager or the registered provider not be resolved. 2 9 3 9 4 16 Care Homes for Older People Page 26 of 27 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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