Care Home: Quebec Hall Christian Eventide Home

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What the care home does well The home has a relaxed and welcoming atmosphere that residents said they enjoyed and that Quebec Hall feels just like their own home. Visitors are made welcome at reasonable times and the home enjoys strong links with the local community. We spoke to residents at this time and comments confirmed that they feel very much at home and that Quebec Hall really is a wonderful place to live. Discussions also confirmed that staff and management are always accessible and that people feel they will be listened to if they had any worries or concerns. The home has an ongoing refurbishment and redecoration programme in place. What has improved since the last inspection? Areas of the home have been decorated since the last inspection and a bathroom has been upgraded and now offers a bright area that supports people to be as independent as possible. What the care home could do better: Care plans in the home are currently made up of separate documents that are kept in a variety of places. Each plan of care must contain all documents and records for that person to enable a full review of care. For example, if the daily records show a person has had a fall, then referring to the section for risk assessments will show that staff have reviewed and assessed the amount of risk identified to that resident and found ways to minimise any such risk. If any injury is sustained, then referring to the medical section will show a GP or hospital appointment. Following such an incident, the daily records section will show how the person has been feeling and if there are any signs that further investigation or medical help is needed. This is just one example of how an individual care plan supports the gathering and use of information if this is kept in one place. Staff training has not been refreshed recently and areas such as awareness of adult abuse must be up to date to make sure staff are aware of current legislation and to fully protect residents in the home. Good practise is for a home to have a fire test to see how long staff take to react and how they deal with various times of the day and different situations. A record of such events would also ensure that all staff have participated at some time and indicate any areas where additional training may be required. This is currently not carried out in the home and this was discussed at this inspection. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Quebec Hall Christian Eventide Home Quebec Hall Quebec Road Dereham Norfolk NR19 2QY     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: Brenda Pears     Date: 0 3 0 4 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. 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. 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Quebec Hall Christian Eventide Home Quebec Road Quebec Hall Dereham Norfolk NR19 2QY 01362692504 01362692504 quebechall@wanadoo.co.uk 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) : Quebec Hall Ltd care home 20 Number of places (if applicable): Under 65 Over 65 2 18 dementia old age, not falling within any other category Additional conditions: 0 0 Two service users, named in the Commissions records, who have dementia may be accommodated. Date of last inspection Brief description of the care home Quebec Hall Trust is a Christian Eventide home providing personal care and accommodation for twenty older people and has a strong Christian ethos. The home is in an attractive Georgian building situated on the outskirts of the market town of Dereham, where all local facilities can be found. Within the grounds there are fortythree bungalows providing sheltered housing, although these are not part of the registration. The building has three storeys and offers accommodation for twenty service users in fourteen single and three double bedrooms. There is a passenger and three stair lifts, two lounges, a dining room and attractive, accessible gardens, with garden house and toilet, which is easily accessed. Quebec Hall is not suitable for service users with severe mobility problems, as a consequence of the frequent change in floor levels. Care Homes for Older People Page 4 of 26 Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced inspection undertaken on the 3rd April 2009 and started at 10.00am. The focus of this inspection was on the previous requirements, on the core national minimum standards and on the quality of life for people who receive support in the home. The methods used to complete this inspection consisted of looking at the care a resident receives and the records that support this. Information was provided to us by the home on an assessment form known as an Annual Quality Assurance Assessment Care Homes for Older People Page 6 of 26 (AQAA). During the visit to the home we spoke to two managers, one member of the trustees for the organisation, with members of staff and with individual residents and also to groups of residents. These methods and previous findings all inform the outcomes of this report. 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. Care Homes for Older People Page 8 of 26 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does assess the needs of any new client to make sure individuals can be fully supported before an agreement is undertaken. However, not all agreements had been signed by the home as well as by the resident and/or their representative. Evidence: A full assessment is undertaken before support is agreed and appropriate staffing levels are provided. Two residents confirmed that information and full discussions were carried out prior to agreements being completed. Three care plans were seen at this time and while assessments had been completed, these had not been signed in all cases. 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. The care plans contain information that enables staff to meet individual needs, but not all this information is in one place. Medication is handled and stored correctly for the safety and well being of those living in the home. Evidence: We looked at care plans and the information that is gathered to inform staff what support is required for each resident. While healthcare needs are being met, staff do not have an independent record of all support that is required drawn together into one record. For example, currently the information known as a care plan is held in one large folder with each person having their details recorded on individual sheets. We had to review other records and documentation before a full picture could be drawn together of the care needs, habits, routines, state of health and the support or care that had been provided by the home. Accepted good practise is for all such information to be drawn together into one file for each person. Discussions were undertaken at this time about Care Homes for Older People Page 12 of 26 Evidence: the development of full, person centred and informative care plans. This would mean that staff would obtain this information at a glance and not have to work their way through a variety of documents to find what is up to date and current. This was discussed with the manager as were the benefits of care planning training. While a case of a resident having a fall is recorded, there is no system for monitoring the frequency or reason for such falls. The manager stated that staff do discuss problems or any falls, but as previously described, an individual care plan would support the gathering of information and the monitoring of the welfare for each person. This would identify any triggers for a fall and help with minimising any further risk. People wishing to deal with their own medication are supported to do this safely and risk assessments are completed. Full information was seen when we looked at daily records. These contained detailed information about how the person had spent their day. The medication was stored appropriately and records of the administration of medication were clearly completed, up to date and medication was stored in an orderly way. The home has been advised about the management of medication and is to obtain a locked fridge for medication to be stored in cooler temperatures. The regulations for the storage of controlled drugs were also discussed and the manager is to get advice regarding appropriate storage. 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. Residents are supported to take part in a range of leisure activities, to maintain contact with family and friends and are offered a variety of healthy meals that they have chosen. Evidence: People living in the home are encouraged to say what they would like in all areas. One such instance was the request for more jacket potatoes. This has now been undertaken followed through with offers of a variety of toppings. The menu is on display in the dining room and people are asked daily what meal they would like. Several people did say that they could have a different meal but comments were that residents would not like to be a nuisance and ask for something different. For example, one person said that they love fried fish but the home cooks the fish with breadcrumbs. When asked if they had asked for battered fried fish, the person replied that they just ask for one of the alternatives on offer. Two people also said that the chips were very hard but they did not let the staff know this at the time. This information was passed onto the manager and discussed at this time. Care Homes for Older People Page 14 of 26 Evidence: Staff asked if people wanted any more food and if they had enough to eat. Not everyone comes into the dining room for meals; some meals are served in rooms when chosen. People can have breakfast in their rooms and get dressed whenever they choose. Regular meetings for discussions have been declined by residents and the home therefore operates an open door policy where people are able to discuss any matters with staff or management. People living in the home told us that there are lots of regular visitors who are made welcome. We saw staff giving people time and not trying to rush them. One new resident arrived on the day of this inspection and said that everyone had been very helpful and staff were making sure that this person had the food they liked at lunch time and also made sure this person was comfortable. A newsletter is issued regularly from the home with details of events such as cream teas, barbeques, quiz and fish and chip nights, knitting club and general informal chats or discussions. 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. Residents know who to complain to and feel they will be taken seriously and appropriate action taken. Evidence: There have been no official complaints made since the last inspection and the manager explained that residents and family/visitors are always encouraged to address any matters immediately with her or a member of staff. This was confirmed through discussions with residents at this time with people saying that they feel safe and comfortable when speaking to staff. Discussions with staff also confirm they are aware of safeguarding issues and what action to take. However, there has been no training regarding adult abuse since 2006 and this is now an accepted part of any training programme where adults are receiving support of any kind. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does provide a safe, clean and comfortable environment that is developed to meet the needs of the residents. Evidence: Quebec Hall offers a comfortable and relaxed environment for people who live there and seven people living in the home said they were very happy and that staff are caring. Each room is personalised and rooms are unfurnished to accommodate as many personal items as the person wished to bring with them. The home continues to be improved through an ongoing maintenance and refurbishment programme. Since the last inspection a new bath has been installed creating a bright and fresh room. Individual rooms are regularly decorated and new carpets installed where necessary. Additional equipment has also been purchased including new wheelchairs, hoists and stand aids. A new ramp is to be installed leading from the main building to the garden area and a new patio will also be developed for residents. A rail to the upper stairwell has been raised following advice from the safety officer. Care Homes for Older People Page 17 of 26 Evidence: It was noted that toiletries are left out in some rooms and discussions were undertaken with the manager regarding the need for risk assessments to ensure these do not present a risk to anyone in the home, particularly with regard to anyone with any degree of dementia. Lengthy discussions were also undertaken regarding the use of a strap across the door of the room for one resident who has been prone to wandering. This is seen as a form of restraint and a risk assessment identifying alternative methods of support is needed on this care plan. An environmental risk assessment is also needed to ensure the suitability of the room for this person. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have their needs met by a consistent staff team, providing stability and continuity of care. However, current recruitment practises in the home do not fully safeguard residents. Evidence: At the time of this inspection the staff team consisted of five care staff, one supervisor, one cook, one kitchen assistant and one domestic person who works five mornings a week. Carers do some cleaning and bed making and domestic staff also help with the laundry. Training information showed that some areas of training had not been refreshed since 2007 and this was discussed at this time. The accepted practise is that areas of core training are refreshed yearly to ensure staff are using current and correct practises and that routines in the home reflect current legislation. While the training information showed when training had been undertaken, it did not show what members of staff had completed the training. To check what each member of staff had undertaken means looking through each staff file to look at certificates and what date these were issued. There is no tracking of what training staff have Care Homes for Older People Page 19 of 26 Evidence: completed and no systems in place to ensure all training is up to date and booked when refreshers are needed. Two staff files were seen at this time and again there is no system in place to ensure that all appropriate documentation is obtained during the recruitment process. One file did not have references and the manager explained that she had received emails in relation to this person. However, there was no method of ensuring that two references are obtained and in light of the fact that the home starts staff without a criminal records check (CRB) and they are then shadowed until this is received, current practises do not fully safeguard the welfare and safety of residents. Discussions with staff showed they knew what the needs were for residents and for the new resident who was admitted. Staff also confirmed they have supervision and know where to find any additional information that may be needed. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that is managed by a suitable person and is run in their best interests. Evidence: A member of the trustees discussed the monthly visits that are completed to ensure the quality of care and the fabric of the building meet with regulations. (Regulation 26 visits). Any new residents in the home are visited by a member of the trustees to find out what the person feels about the admission process and to ask about their likes and dislikes. This information is then included in their personal file and any food choices are passed to the kitchen. All equipment that requires servicing had certificates that are up to date covering such things as hoists, shaft lift and stand aids. Care Homes for Older People Page 21 of 26 Evidence: Policies and procedures are in place and a copy is kept in the main entrance hall for easy access. Policies cover such areas as bullying, whistle blowing, complaints and residents rights. There was information about abuse, different types of abuse and policies on who to contact and relevant contact details. While there is a fire risk assessment in place for the home, staff do not have an unannounced fire practice at present. This was discussed in depth as if staff only hear the bell on a planned practice, there is no opportunity to assess the relevance of any fire training and the competences of the staff group. Quality assurance questionnaires are issued on a regular basis and although the response is not always good, this and information from direct discussions with residents, inform any developments in the home. Questionnaires are also left in the hallway for visitors to complete if they wish. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 13 The registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. To fully protect residents in the home, staff must undertake training on awareness of adult abuse and have this training refreshed as appropriate. 31/08/2009 2 19 13 The home meets the individual and collective needs of residents in a comfortable and homely way. That each allocated room meets the needs of the individual in a homely way and does not present any risk. In this instance with particular regard to toiletries and the use of any means of 30/06/2009 Care Homes for Older People Page 24 of 26 containment. Each case requires risk assessment to identify and minimise any risk. 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 3 That all completed assessments of care are signed by the resident and/or their representative to confirm their agreement with the plan of care. For good practise, a full care plan must contain all information that relates to the care and support needed by each resident for their welfare. Systems must be in place to monitor all incidents of falls in the home and subsequent action taken to minimise any risk and prevent repeated falls. 2 7 3 8 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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