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Care Home: Rose Lodge

  • 2 Isca Road Exmouth Devon EX8 2EZ
  • Tel: 01395227071
  • Fax:
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Rose Lodge formerly The Mulberry is registered to provide accommodation and personal care for up to 25 older people with a dementia type illness. They may also care for older persons with mental health problems. The property is a large detached and extended house in a secluded residential area of Exmouth. The home is approached by a private driveway, has pleasant secure gardens and parking on site. The accommodation is arranged over the first and ground floors, with a passenger lift to the first floor. The lounge and dining areas are designed in an open plan arrangement and are situated on the ground floor. The current weekly charges range from GBP380- GBP480. Items not included in the fee include chiropody, hairdressing and clothing. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at httpwww.oft.gov.uk CSCI Inspection reports are available on request from the manager.

  • Latitude: 50.61600112915
    Longitude: -3.3989999294281
  • Manager: Manager post vacant
  • Price p/w: ~
  • UK
  • Total Capacity: 25
  • Type: Care home only
  • Provider: Eminence Care Ltd
  • Ownership: Private
  • Care Home ID: 16272
Residents Needs:
mental health, excluding learning disability or dementia, Dementia

Latest Inspection

This is the latest available inspection report for this service, carried out on 13th May 2010. CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

For extracts, read the latest CQC inspection for Rose Lodge.

What the care home does well The home has a good admission procedure, which encourages people to visit and ensures that the right level of information is gathered before someone moves to the home. Medication is well managed with clear records. Attention has been paid to promote people`s choice and maintain people`s dignity by the practice of the staff and the ethos of the home. There has been a notable improvement in the activities available to people living at the home. There is a set timetable of external entertainers each week, which runs alongside the one to one and group activities/occupations devised by the home`s experienced activities co-ordinator. People look relaxed and we saw many people actively engaging with the life of the home, which has created a positive atmosphere. There is a clear complaints procedure and staff understand their responsibility to respond to concerns and complaints, as well as their duty to safeguard the people in their care. The home is clean and odour free. Design changes now encourage people`s independence, and people move round the home to find an area of the communal room that suits their mood or purpose. Staff and people living at the home have benefited from a much improved training programme, particularly the focus on high quality dementia care training. The home is committed to assessing the quality of their care and involving people living, working and visiting the home in providing feedback on the work they do, as well as reacting positively to suggestions. The home is well run and well maintained. What has improved since the last inspection? The service has worked hard to address the seven requirements from the last key inspection, which have now all been met. There have been improvements to the quality of care plans, which helps promote people`s well-being and safety, and provide an accessible and consistent approach to care. People`s health needs are now met in a more affective manner, including their mental health needs, by well trained staff, who are caring and insightful. The administration of medication has improved by careful auditing and further training. Staff recruitment is now robust with clear systems in place to ensure that people are suitable to work with vulnerable people. Staff induction is being addressed by the new manager. Finally, there are monitoring systems now in place to ensure that the temperature of hot water is controlled. As part of the last inspection, we made seven recommendations to improve practice and the home has addressed all these areas, which included reviewing people`s care, promoting people`s dignity, better recording of complaints, assessing the quality of care and monitoring risk. A greater range of physical and mental stimulation is now provided for people living at the home, which has had a positive impact on people`s well being. What the care home could do better: As a result of this inspection, we have made one requirement to fit a cover to an unprotected radiator in a communal bathroom, which has a timescale for completion. We have made three recommendations to promote best practice; the first to put in place guidance for staff on the use of PRN medication, the second to notify CQC appropriately about events at the home and a third recommendation that the acting manager of the home should be registered with CQC to promote stable leadership at the home. Key inspection report Care homes for older people Name: Address: Rose Lodge 2 Isca Road Exmouth Devon EX8 2EZ     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: Louise Delacroix     Date: 1 3 0 5 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 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 32 Information about the care home Name of care home: Address: Rose Lodge 2 Isca Road Exmouth Devon EX8 2EZ 01395227071 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Eminence Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 25. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: DementiaCode DE- maximum 25 places Dementia, over 65 years of age- Code DE(E)- maximum 25 places Mental disorder, excluding learning disability or dementia- Code MDmaximum 25 places Mental Disorder, excluding learning disability or dementia - over 65 years of age -Code MD(E)- maximum 25 places Date of last inspection Brief description of the care home Rose Lodge formerly The Mulberry is registered to provide accommodation and personal care for up to 25 older people with a dementia type illness. They may also Care Homes for Older People Page 4 of 32 Over 65 25 25 25 25 Brief description of the care home care for older persons with mental health problems. The property is a large detached and extended house in a secluded residential area of Exmouth. The home is approached by a private driveway, has pleasant secure gardens and parking on site. The accommodation is arranged over the first and ground floors, with a passenger lift to the first floor. The lounge and dining areas are designed in an open plan arrangement and are situated on the ground floor. The current weekly charges range from GBP380- GBP480. Items not included in the fee include chiropody, hairdressing and clothing. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at httpwww.oft.gov.uk CSCI Inspection reports are available on request from the manager. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was unannounced and lasted approximately ten and a half hours. There were 18 people living at the home. During this time we spent time talking with people who live, work and visit the home. We spent time in the communal areas of the home at different times throughout the day to help us build a picture of what life is like for people living at Rose Lodge. This included spending time in the dining room at lunchtime, and during this time we used a tool that helps us measure peoples sense of well being and the skills of the staff who support them, as well as seeing how people are engaged with the world around them over a set period of time. This is called a short observational framework for inspection (SOFI). Usually this takes place consistently over two hours but on this occasion it lasted one hour as one person we were sitting near wanted to talk to us and questioned why we were writing. So we stopped recording our observations and sat and chatted with them. As part of the inspection we also case tracked three people. This means that where Care Homes for Older People Page 6 of 32 possible we met with them, talked to staff about the type of support they need and look at the written records relating to their care. We also looked at other records, including recruitment, staff training and incident and accident reports. We visited different parts of the building, including communal areas, staff areas and peoples individual bedrooms. The home looked welcoming and there was a calm and friendly atmosphere. We also spent in the time in the garden and saw how people living at the home reacted positively to their surroundings. Prior to the inspection, the acting manager completed an Annual Quality Assurance Assessment (AQAA), which provides details about how the home is run. We have referred to this document in our report. We also sent out surveys to people who live, work and visit the home. We had six surveys from people living at the home, some of whom had been helped by relatives/spouses. Five staff members also completed surveys. We have included the outcome of these surveys within the report. The last time we inspected the home was in January 2010 when we received an anonymous complaint expressing concerns about the warmth of the home and staffing levels at the weekend. We visited on a Saturday afternoon and found that staffing levels were appropriate, the atmosphere was calm and the home was warm with temperatures monitored and recorded. We met with the owner and the new manager in February 2010 to discuss the improvements being made to the home and to monitor the progress of meeting the requirements made on the last key inspection. We have also liaised with other agencies regarding the quality of care provided at the home. There have been significant improvements since the last key inspection. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: As a result of this inspection, we have made one requirement to fit a cover to an unprotected radiator in a communal bathroom, which has a timescale for completion. We have made three recommendations to promote best practice; the first to put in place guidance for staff on the use of PRN medication, the second to notify CQC appropriately about events at the home and a third recommendation that the acting Care Homes for Older People Page 8 of 32 manager of the home should be registered with CQC to promote stable leadership at the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a good admission and assessment practice, which ensures that the home is able to meet their needs. Evidence: We looked at care records for three people living at the home. These included a detailed assessment, which is updated to reflect peoples changing care needs. These records showed that a full assessment had been carried out by the manager, which recognised the range of care needs that people have, including physical, mental health and social and emotional needs. Part of the assessment includes a pen picture of the persons social history . Identified care needs then form the foundation for the homes care plan, which is written for each person. Staff told us in their surveys that they had enough support, experience and knowledge to meet the different needs of people living at the home, which demonstrates that the home does not admit people inappropriately. Care Homes for Older People Page 11 of 32 Evidence: Four out of six people living at the home who completed a survey for CQC (supported by relatives) said that they had received enough information about the home to make a decision whether it was the right place for them. Other people were unsure if they had received information. We also met a relative who told us they had been provided with written information about the home. In the homes AQQA, it states that there are plans to make changes to the pre admission assessment to include what the individual will contribute to the home and how the person will relate to the other residents. This shows how the home is treating each person as an individual, as well as recognising the importance of achieving a good atmosphere within the home. The home does not provide intermediate care. In their completed AQQA, the home recognises the need to resist pressure to admit people quickly but instead to ensure that new admissions are planned to allow care plans to be put in place. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from living at a home where their individual physical, psychological and emotional needs are met by well informed staff. Evidence: Since the last key inspection, a new manager has been appointed and they told us they have reviewed the previous care planning system and introduced a new way of recording. The manager told us that the current care plans are work in progress. We looked at three care plans to see how information is recorded and shared with staff. The care plans are up to date, include risk assessments, personal preferences and provide guidance to staff. We saw that these care plans are regularly reviewed. The home has introduced a system to help measure peoples well-being levels; we saw examples of how staff record these observations and the manager told us that these will be incorporated into reviews. These records showed us how staff are recognising people as individuals and the task means that staff begin to consider what the care looks and feels like for the people that live there. This was demonstrated throughout the day by good staff practice. Care Homes for Older People Page 13 of 32 Evidence: During the day, we saw a plan being updated to reflect changes. We also heard staff being verbally updated about changes that had occurred in peoples care and health needs, and we were told that there were handovers at the start of each shift to update staff. We observed one of these handovers, which contained pertinent information for the staff coming on duty. We looked at care records that showed peoples changing health needs are recognised, and conversations between staff confirmed this. We also observed how staff were quick to pick up on peoples changing moods, offering reassurance when people were upset, and subtly intervening when people became distressed or agitated. A good level of observation by staff and appropriate intervention meant that throughout the day the atmosphere remained calm and relaxed. This included responding to peoples need to visit the toilet. A visitor told us that they visited at different times of the day and always found the home to have a calm atmosphere. There was one period that lasted approximately ten minutes that occurred after lunch when some people became restless but when this happened the manager responded quickly to support the staff team, and peoples needs and wishes were soon met. Health records are well written and discussions we had with staff about peoples health needs were well documented. The homes AQQA states that there are two people were admitted with pressure sores. We saw that there is guidance to reduce peoples risk of pressure sores. We also saw a two hourly turning regime for someone assessed as at risk, and saw that people identified as at risk of skin damage were sitting on pressurerelieving cushions. Staff confirmed that people also had access to pressure relieving mattresses. Daily records showed increased level of detail when people become ill to help monitor their health and well-being. Records show that people have access to the services from chiropodists, opticians and dentists, when needed. We looked at how weights are recorded, and records for the three people we case tracked showed that peoples weight is stable and monitored regularly. We heard that charts were kept for people who were identified as having poor appetites, and staff had a clear overview of how much people had eaten during the lunchtime meal. We saw that the descriptions of peoples eating habits in peoples care plans reflected our own observations during lunchtime showing that the care plans are working documents. We saw that medication was well managed at the home and that it is stored in a safe and appropriate manner. Records were completed appropriately, and staff told us that the number of people administering medication has now been reduced, which the manager told us improved medication management. It also provides a clearer audit Care Homes for Older People Page 14 of 32 Evidence: trail, which is good practice. We saw medication being safely administered, with the staff member checking that people had taken their medication. Staff told us that they had recently received an update on their medication practice. We saw a recent report from a visiting pharmacist, which confirmed that medication is safely managed. Staff were clear about advice they had been given and showed us how they were already implementing good practice recommendations as advised by the pharmacist. We heard examples of staff advocating for people living at the home regarding their medication, and we were told that the home is currently working with GPs to have peoples prescribed medications reviewed. This includes seeking more detailed guidance for the administration of PRN medication. We spoke to the home about ensuring that there is clear guidance and home protocol as to when these medications are given. As part of the inspection, we looked to see how peoples dignity and privacy is maintained at the home. People told us in their surveys that staff listened to them, and we observed this to be the case throughout the inspection. Staff took time to make eye contact and be at the same level as the person they spoke with. We saw staff explaining to people what they were going to do before they carried out a care task, for example explaining how they were going to help someone move. Staff acknowledged peoples past achievements and roles in life, as well acknowledging help that people provided around the home, which also helps maintains peoples dignity. We saw staff ensured that nobody was left wearing a protective apron after they had finished their meal. We heard people discreetly being offered help with maintaining their continence, and a staff member responding sensitively to someone who needed to change their clothing due to incontinence. We heard staff checking with someone where they would like to sit to eat their lunch, we read in care plans how peoples preferences are recorded, and we saw this preference being supported when lunch was served. People generally looked well cared for, wearing clean clothes and with clean nails; some people proudly showed us their painted fingernails. A visitor told us this was usually the case. Staff recognised when people had been visited by the hairdresser and complimented them on their hairstyle, which people responded positively too. The provider told us that they plan to convert an unused room into somewhere for people to have their hair washed and cut, as well as providing somewhere for nail care, massages etc. We spoke to two members of staff, who were very positive about this plan. One told us that they are qualified to provide suitable therapeutic treatments and both staff members were very clear about the benefits to peoples well-being. CQC have received praised from a family whose relative died at the home. They told Care Homes for Older People Page 15 of 32 Evidence: us how skilled and caring the staff were. The family are professionals in end of life care, which gives extra credence to their compliments. We saw a card from relatives that thanked the staff for the sensitivity of all the carers helped (their relative) to maintain (their) dignity. The homes manager told us that they act as a role model for staff and act as the main carer for people reaching the end of their life because of their experience in this type of care. We saw from the homes notice board that training is booked for staff in this area of care. However, there is currently no record of peoples resuscitation wishes; we advised that this should be recorded once a multidisciplinary meeting has been held if the person does not have capacity in line with the Mental Capacity Act. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Rose Lodge benefit from the homes commitment to offer varied activities and occupation, which helps keep them stimulated and provides an improved atmosphere in the home. Evidence: The homes AQQA gave us detailed examples about how people are supported with their daily life and social activities. During the inspection, we saw many examples to confirm the information provided. For example, we saw that regular activities are planned, with the information displayed in the lounge. On the afternoon of our inspection, a quiz took place run by an external entertainer. Some people taking part were supported by staff, while others answered independently, with everyone being praised and listened to amidst laughter and a relaxed atmosphere. The home is also visited by a visiting musician, and the provider told us that the style of music has been adapted to suit peoples interests. Staff were aware of the benefits that people gained from group singing, both to their memories and their sense of well being. We also heard from staff and a relative about a theatre trip that had taken place and other trips in the local area. A person visiting the home told us they always felt welcomed by staff and we saw another visitor being greeted warmly by staff and Care Homes for Older People Page 17 of 32 Evidence: being offered tea while they sat and chatted with their spouse. We looked at how peoples social needs are met and how they are supported. A significant boost to the activities is the recent appointment of a new activities coordinator at the home, who we were told works at least six days a week in the mornings and afternoons. Staff in their surveys recognised the need to concentrate on activities and stimulating occupation. One person said that in relation to activities that the staff often join in, it is a lot of fun. While visitors generally felt that the home arranged activities that their relatives could take part in. We spoke with a staff member, who is experienced in this field and has a creative and innovative approach to providing stimulating one to one support and group activities to help confirm the above. The homes newsletter has pictures of a recent VE Day celebration, as well as pictures of people taking part in gardening and choosing plants at a garden centre. There has been significant work to make the large garden an attractive and welcoming place to be with raised flowerbeds and plants and vegetables grown by the people living at the home. During our visit, we saw people being supported to access the garden, watering plants and feeding the fish. They looked relaxed, interested and interacted with the staff commenting on their surroundings. The home also plans to install a chicken run to add further stimulation for people living at the home. We saw how staff used activities and meaningful occupation to allay people anxieties, such as peeling potatoes for lunch and painting. A person visiting the home commented on the sense of calm in the home, and we noted that the atmosphere had improved since our last visit with people being occupied and staff appearing confident in their roles. A staff member commented in their survey that the home is now a happy environment. The home has had performances from local schools to provide contact with the wider community, and an invitation have been sent out for a combined garden party and open day at the home. Throughout the day, we heard people being offered choices in a day to day context, such as where they sat, a choice of drink, and what they did to occupy themselves. We saw in one persons care plan that they liked to sit separately from others when eating their meal and we saw that this was respected. Staff were observant about peoples eating habits, and provided alternatives when the person seemed reluctant to eat. We saw that there was a choice of two meals, and staff explained how this choice was offered, but also confirmed that extra portions were made in case people changed Care Homes for Older People Page 18 of 32 Evidence: their mind on the day. We were told that people had been involved in choosing how the signs for their individual doors were worded, with one person choosing to acknowledge their past war role through an individualised sign and picture. Some people had chosen to have their first name on the sign and others had opted for a more formal approach. The main meal was well presented, with a selection of vegetables and served on appropriate crockery, and smelled appetising. We watched how a number of people seemed to really enjoy their food, making appreciative noises as they ate and requesting more. People were offered a range of cutlery to meet their needs and staff intervened sensitively for those that needed support. We heard staff informing people what the meal was that they were being served, and although one person had forgotten what they were told, we heard them commenting I dont know what I am eating, but its quite nice. Later in the day, people were given a buffet lunch, which included lettuce grown in the homes garden. We saw home made cakes for tea and saw that the kitchen was well stocked. The manager told us that they plan to review the meals served at the home, and told us that the appointment of a breakfast supervisor meant that there was a consistent approach to breakfast with a staff member who could greet people and oversee how much people had eaten. We saw that for those people with a small appetite have their portions and how much they have eaten recorded in a meaningful way. Recently the home has sought advice from the Speech and Language Team to ensure they were supporting some with swallowing difficulties in an appropriate manner. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has responded to complaints in a timely manner, and has shown that the safeguarding of the people living at the home is taken seriously. Evidence: Since the last key inspection, we have received have received two anonymous complaints about the service relating to staffing levels. One also raised concern about the warmth of the home. One was referred to the home to investigate and we have written to the home to advise that different sources should be incorporated into the investigation to make it more robust. The other anonymous complaint resulted in CQC carrying out a random inspection on a Saturday that reassured us that there were suitable staffing levels and that the home was warm. The home has provided responses to CQC for these complaints, with no further action being taken by CQC. In the homes AQAA, it is recorded that there have been 8 complaints in the last 12 months and that these were both resolved within 28 days. With 4 of the complaints upheld. We looked at the recording of complaints which has improved and is clearer. A relative told us that staff were approachable if they had a problem, and six visitors told us in their surveys that generally they knew who to speak to informally if they had a problem and five knew how to make a formal complaint. The manager has contacted the safeguarding team for advice, and the home has demonstrated its commitment to a professional staff group by using their disciplinary Care Homes for Older People Page 20 of 32 Evidence: process to deal with serious unprofessional behaviour. The homes AQAA states that safeguarding training is provided for all staff, and four out of five staff said they knew what to do if someone has concerns about the home. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Changes to the homes environment has made the home a more attractive place to live and has increased peoples independence. The home is clean, odour free and well maintained, which makes it a pleasant place to live. Evidence: As part of the inspection, we looked to see how the building is maintained and if it is a homely place to live. There have been improvements to the appearance of the home, both externally and internally, as well as to the layout of the communal areas. These improvements have been made to help compensate for peoples mental health needs. The communal areas are clean and we saw fresh flower arrangements, attractive tablecloths and place settings. The home has invested in a new carpet for the communal areas, thought has been put into making it an appropriate colour and style, which includes ensuring that it a continuous stretch of carpet without dividers as the owner is aware that this can cause a visual disturbance for people with dementia and prevent them moving around with confidence. We saw that people looked relaxed in their surroundings, moving around freely. Some people, we met told us they preferred to sit at the dining rooms tables, where staff joined them to look though the local paper with them. Throughout the day, we saw care staff joining people to sit and chat, which included looking at magazines and newspapers, which people seemed to really enjoy. Care Homes for Older People Page 22 of 32 Evidence: One visitor commented that thought had been put into making the home look more homely, which includes fresh flowers, plants and chairs around the communal areas so that people can watch the life of the home from different positions. The home has a level garden with raised flowerbeds, which were planted with plants chosen by people living at the home, as well as vegetables sown by them. We saw photos of people involved in these tasks. We looked to see if peoples rooms are kept clean, and spot checked several rooms. All rooms were clean and odour free, with satisfactory beds and bedding. Bedroom doors display an individualised sign for the rooms occupant, to help people identify their own room. Signage for other areas of the home was clear and well positioned to help promote peoples independence. During our visit we saw that a new maintenance person had been appointed, who was clear about their role to over see the safety and maintenance of the building. They confirmed with us that specialist heating advice was sought and confirmed that thermometers were in all the rooms, which we saw in the rooms we visited, to monitor room temperature. All the rooms, we visited, were warm. We looked at the range of bathrooms available at the home, and saw that there was a specialist bath and hoists, staff told us about their plans to make the environment more attractive to help make peoples bathing experience more relaxing and enjoyable. However, one bathroom on the ground floor does not have a covered radiator, which could potentially put people at risk of burns. We looked to see how infection control is managed within the home to help keep people safe. We saw disposable gloves were freely available, and we staff using these appropriately when responding to an incident that required infection control measures. We saw from records that staff are trained in infection control, and the manager told us that she carried spot checks to monitor staff practice when providing personal care. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from being cared for by a knowledgeable and caring staff group; who are recruited in a robust manner and at appropriate levels, and who have access to high quality training. Evidence: The homes AQAA states that 18 staff are employed over all departments. On the day of our inspection, the level of staffing met peoples needs because people were not kept waiting, staff responded quickly and appropriately to peoples changing needs, and people living at the home appeared contented and stimulated. Four care staff were on duty in the morning and three in the afternoon. The manager told us this was based on the current number of people living at the home. In their surveys, three staff said there was sometimes enough staff, one said there usually was and one said there was always enough staff to meet the individual needs of people. The role of the activities coordinator means that even when care staff were busy meeting the ranging needs of people living at the home, there was someone to spend time with groups of people or individuals to offer mental and physical stimulation. We saw that the staff team across the home have a range of skills and experience and appeared confident and at ease with the people living at the home. The homes AQQA states that agency staff have been had been used in the last three months, but we were told that there are now plans to build on a group of bank staff so that agency Care Homes for Older People Page 24 of 32 Evidence: staff will not need to be relied on to cover sickness, holidays etc. There are a core group of staff who have worked at the home for some time, supplemented by new staff who bring their own skills and experience with them. We were told that recruitment is no longer a problem for the home as word has spread that it is pleasant place to work. A relative commented in their CQC survey that the home could be improved by not so many management changes and staff changes. The owner and manager said that since the surveys the home has been a more settled and stable workplace, and staff sickness levels have been reduced. Throughout the day, staff were busy but generally communicated well with one another, and the people they were supporting. For example, we observed staff working well as a team when supporting people to move by using equipment. Staff were able to change their approach to meet the different needs of individuals, and showed compassion and an understanding of peoples individual anxieties and life experiences. Relatives told us that staff were patient, they make sure that residents are kept clean and well looked after and another person commented over all care and attention is very good indeed. When we looked at how people living at the home interacted with staff, we saw that they were relaxed and at ease with them. People were not afraid to make their wishes known and staff responses showed they knew individuals well. The homes AQAA states that almost fifty percent of permanent care staff hold an NVQ 2 in Care or Health and Social Care, which is a good achievement given the staff changes. In our discussions, we were told that newly recruited staff were qualified to this level or over this level. We looked at the recruitment files for three staff who have joined the home since our last inspection. There has been a significant improvement in the practice of the home, which helps keep the people living there safe. There was a clear recruitment process, including appropriate timing for POVA First checks and Criminal Record Bureau Checks [CRBs], with gaps in employment history explained, interview notes, identification and two written references. Since the last inspection, the home has significantly invested in training for their staff, which has had a positive outcome both for the people living at the home [see evidence throughout the report regarding peoples well-being] and the staff group. Details of training were recorded in the homes AQAA, were described to us by staff and the outcome was observed during our inspection. Staff told us in their surveys that the training and induction they received enabled them to meet the needs of the people they cared for. We saw from records and through our discussion with staff, that the manager has a Care Homes for Older People Page 25 of 32 Evidence: systematic approach to training to ensure that mandatory training is up to date, and supplemented with more specialist training, such as end of life care. The home has invested in a four day course in dementia awareness from a well established company, which was available to all staff to help support a consistent and confident approach by staff. Discussions and records confirmed that the training is a mix of DVDs, in house, external trainers and observation to monitor the quality of peoples practice. Staff generally felt that their induction met their training needs. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Since the last key inspection, there has been a change to the management of this service. The current management team have shown a commitment to ensure that the home is run in the best interests of the people living there and improvements are ongoing. Evidence: There is no longer a management company involved in the running of the home. Instead, the owner has become more hands on and appointed an experienced manager who has previously worked in a dementia care home. The manager told us that their application to register with CQC as the homes manager is nearly completed, and they are clear about the timescales that have been set by CQC for this application to be submitted. During the inspection, we talked with the management team about how they monitor the quality of the service. We were told by the management team that there was on going work to keep families informed of changes within the home, through bi monthly Care Homes for Older People Page 27 of 32 Evidence: newsletters and relatives meetings. We read the minutes from meetings with people living and working at the home, and saw examples of how people can influence the service, and how these have been actioned. We saw that the home has been innovative about involving a person living at the home in some staff interviews, which they felt had been very beneficial both to the quality of the interview, to promoting the ethos of the home and to the persons sense of well-being. The AQQA states that they have moved the managers office to the lounge area so that the manager can stay in close touch with residents, relatives and friends, and staff, so making her accessible but also enables her to monitor the quality of care and the well-being of people living at the home. We saw evidence of the meetings between the manager and the owner that review specific areas of development for the home. We also saw that the manager has introduced an auditing system to measure the quality of care, for example medication administration. We were told by the owner and the manager that the home does not hold peoples personal allowances, and instead relatives are billed on a regular basis for additional expenses. As part of the inspection, we looked to see how practice within the home keeps people safe. During our tour of the building, we spot checked individuals rooms and saw that radiators were protected and windows restricted to help keep people safe. However, one communal bathroom does not currently have a covered radiator, which needs to be addressed promptly to help keep people safe from burns. We saw that people were moved in a safe manner, and the staff records we looked at showed that training in this area of care was up to date. The home has also recruited a staff member who in the future will be able to provide further training in this area. The homes AQAA states that staff have had training in infection control, and staff practice during our inspection confirmed this as did staff explanation about how practice at the home maintained good infection control procedures, including providing paper towels and liquid soap in peoples rooms. The homes AQAA confirms that the homes policies are up to date and that equipment has been serviced on a planned basis, which a spot check of paperwork confirmed. Staff showed us the maintenance records, which include monitoring water temperature, and we were told that since our last visit mixer taps have been fitted to help keep the water temperature at safe levels. The owner confirmed that the homes fire risk assessment had been updated, and evacuation practices had taken place. In most cases, the home has followed the Care Standards Act requirement to notify Care Homes for Older People Page 28 of 32 Evidence: CQC about specific incidents at the home but there have been occasions when this has not happened, which needs to be rectified so that we can monitor how the home responds to situations or incidents. We saw that the manager has monthly monitoring systems in place to oversee the standard of care and the risks within the home. For example, the number of falls in the home which are low. Care Homes for Older People Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 25 13 A risk assessment for individual uncovered radiators in the home must take place, and action taken to guard the radiator if the risk is medium or high. This is to help protect people from the risk of burns from a hot surface. 01/07/2010 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 home should put in place clear guidance and a protocol for staff regarding the triggers for the administration of PRN medication e.g. for pain relief. The acting manager should be registered with the CQC as soon as possible to provide stable leadership at the home The management team should ensure that CQC are notified of all incidents listed under regulation 37 of the Care Standards Act. 2 3 31 37 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!

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