Care Home: Royal Cambridge Home

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What the care home does well All people that wish to use service benefit from a pre-admission assessment and the care plans are then generated from this initial assessment. Most of the assessments take place at the home as the manager told us that people wishing to use the service are invited to the home where possible. The staff were observed to be interacting and speaking appropriately to the people using the service in a calm manner. The standard of catering is good and people using the service, who we spoke to, were complimentary about the quality of the food provided. The home is situated in well maintained grounds. People using the service are able to make use of the gardens which are easily accessible. Regular training takes place and this includes the NVQ (National Vocational Qualification) which all staff have access to. The manager has a good knowledge of the home and the people living there. She also has made many changes since her appointment demonstrating a clear vision for the service and where she wishes to take the home in order to improve the quality of life for the people using the service What has improved since the last inspection? Following the last key inspection in October 2007 three requirements were made and these have now been met. All staff recruitment folders had been reviewed to ensure they contain all the information required prior to employing a person at the care home. They have also reviewed the folders of the current staff to ensure those folders are up to date. The laundry has now been risk assessed and all chemicals or fluids are now locked away. What the care home could do better: No requirements were made following this inspection. A discussion took place with the manager regarding the recruitment folders. It was noted in two recruitment folders that gaps had not been fully explained. The manager and training coordinator who carry out the interviews gave an explanation for this for both folders. For specific reason these particular gaps could not be fully explained but they should be placed securely and available for inspection. Key inspection report Care homes for older people Name: Address: Royal Cambridge Home 82-84 Hurst Road East Molesey Surrey KT8 9AH     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: Lesley Garrett     Date: 0 8 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Royal Cambridge Home 82-84 Hurst Road East Molesey Surrey KT8 9AH 020-89793788 02089416897 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Royal Cambridge Home for Soldiers Widows Name of registered manager (if applicable) Ms Angela Clements Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 30 The registered person may provide the following categories of service only : Care Home only-(PC) to service users of the following gender:Female: Whose primary care needs on admission to the home are within the following categories : Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home The Royal Cambridge Home was founded in 1851, and provides care for the widows and female dependents of all persons who have served in the Armed Forces. It also includes women who themselves have served in the armed forces. Care Homes for Older People Page 4 of 26 Over 65 0 30 30 0 Brief description of the care home Care and accommodation is provided in single bed-sitting rooms in the two Victorian houses that are interconnected by a corridor link of more modern rooms. The property is situated in large attractive gardens near to Hampton Court. There is ample car parking space available on the site. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of the care home was an unannounced Key Inspection. Mrs Lesley Garrett, Regulation Inspector, carried out the inspection and the registered manager represented the service. We arrived at the service at 09:45 and were in the home for five hours. It was a thorough look at how well the home is performing. It took into account information provided by the home and any information that CQC has received about the service. The manager for the service supplied CQC with an AQAA (Annual Quality Assurance Assessment) and this document was used to assist with the inspection. We spent time talking and observing some of the people using the service and speaking with some staff members. We looked at how well the service was meeting the key national minimum standards and complying with the regulations and have in this report made judgements about the Care Homes for Older People Page 6 of 26 standard of the service. Documents sampled during the inspection included the homes care plans, daily records and risk assessments, staff files, training records and the homes safeguarding and complaints policies and procedures. From the evidence seen by us and comments received, we consider that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 26 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. People who wish to use the service benefit from a pre-admission assessment from a suitably trained person to ensure that the home can meet their needs. Evidence: We looked at the service user guide and statement of purpose. They contained all the information required for people to make a decision about living at the home. The manager told us that all people that are admitted to the home have a preadmission assessment which she carries out. We were told that all people wishing to use the service are invited to the home so that assessments can take place there. The manager said this also allows the ladies to look around the home, meet other people using the service and to see their room before they decide to move in. If the person is too unwell or lives too far away the manager will visit that person to carry out the assessment. Care Homes for Older People Page 11 of 26 Evidence: The pre-admission assessments cover all the activities of daily living and contains details of next of kin and any medication taken.The manager also told us that the GP visits very shortly following an admission to do a medical assessment. The home does not offer intermediate care. Care Homes for Older People Page 12 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 health and personal care needs the of people using the service are based on their individual needs which are all clearly documented and stored in individual folders. Evidence: Two care plans were sampled and these contained details about each person using the service.The manager told us that she had changed the format of the care plans, since she had been in post, to make them user friendly for the staff. This allowed the staff to deliver care using the supplied information. Preferences were clearly stated throughout the care plans which demonstrated that good assessments had taken place and there had been consultation with each person using the service. Risk assessments were also in place and these were clear with evidence that all had been reviewed and evaluated every month. People who use the service and their relative or representative are involved in the writing and reviewing of all care plans. A discussion took place with the manager as not all people using the service had a nutritional risk assessment in place. She told us that they were only used for those people who appeared to have a problem which was identified during their monthly weight recordings or if there had been a change in their condition. The manager told us that Care Homes for Older People Page 13 of 26 Evidence: she would now complete a nutritional risk assessments for all people. Aids and equipment are provided to encourage maximum independence for people using the service and these are reviewed and replaced to accommodate peoples changing needs.The manager told us that the district nurses will supply beds or pressure relieving mattresses if required by an identified person in their care. The manager told us that the GP visits every week to see those people using the service who need a visit or who have requested one. The manager told us that the GP was a good support to the home and that they would visit the home more often if someone was unwell.The home also has the support of of the district nurses who visit those people with specific health care needs identified by the staff or GP during a visit. The manager said they will do their routine visits but will also visit in an emergency if required by the home. The home also has the services of a chiropodist and opticians who visit regularly. The dietitian and speech and language therapist are available following a referral by the GP. The manager said that families and friends will often take them to see health care professionals for example the dentist if the choose this. There are medication policies and procedures in place. The manager told us that all medications are delivered every month and are in blister packs. They are supplied by a large chain pharmacy. The manger said that emergency medications for example antibiotics can be obtained from the GP practise as they have a small pharmacy on site. All staff that deal with medications have received training and the documentation demonstrated that. The home uses a distance learning programme. Some of the people using the service are self medicating and evidence was seen that risk assessments were in place which are audited each week. Lockable facilities are available to those people. During a tour of the building it was observed that staff were speaking appropriately to the people using the service by their preferred name which had been documented in their care plan. All people were dressed in clothes appropriate for the weather with hair well groomed and nails clean. Staff were knocking on peoples bedroom doors prior to entering and responding to the call bells within a reasonable time. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to take part in social, religious and recreational activities and are able to exercise choice in their daily lives. The quality of the meals is good which means nutritional needs should be met. Evidence: We met the activity organiser on the day of inspection. She works every day Monday to Friday but can be flexible depending on the needs of the people using the service. We were told that an activity takes place every day and this is in consultation with all the people and what they would like to do. Every Friday there is always a regular activity which is a chat with tea and cake.The activity organiser told us that favourite activities for the people using the service include the knitting circle, skittles, a bean bag game and quizzes. We were told that one person using the service will often write the quiz for that week. The home also has a mobile shop trolley. Every week it is set up in the lounge and will also visit bedrooms for those people unable to get to the lounge. The activity organiser is assisted with this by a person using the service. We spoke with this lady and were told a variety of things are on sale including sweets, toiletries and greeting Care Homes for Older People Page 15 of 26 Evidence: cards. It was observed that social preferences with regard to activities, past hobbies and interests were all documented in the care plans or in the activity record maintained by the organiser. The manager told us that visitors are welcome in the home at any time and the home promotes open visiting. On the day of inspection it was observed that people using the service had visitors during the day in individual bedrooms and in the communal areas. The local Rainbow and Brownie groups visit the home at least twice a year and a local school who sing for the people. The activity organiser told us that the school had been the previous week to sing following their harvest festival. The home has a chapel and a service takes place there twice a month. The home also has a minibus and days out have been enjoyed which included visits to the seaside, garden centres and Brooklands for shopping. People using the service who have limited mobility can enjoy trips to the local parks where they do not have to leave the minibus if they choose not to. The manager told us that on a recent environmental health officer visit the home was awarded four stars. Consultation regarding menus takes place with the people using the service.The manager said that different dietary needs can be catered for and if people using the service require pureed or soft diets the dietitian or speech and language therapists are consulted. The manager told us that relatives are welcome to stay for meals and that the home held a special lunch for Mothers Day and the dining room was packed. We met the chef who was very passionate about the food that he prepares and is helped in the kitchen by an assistant chef. The main meal of the day is at lunchtime and the home employs a member of staff to come in to organise the suppers.Choice of food is always available and people spoken to on the day were complimentary about the quality of food on offer. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that their complaints are listened to and that they should be protected from abuse as the staff team have received training in safeguarding adults. Evidence: The manager said that during the last year they had received one complaint. This had been investigated and resolved. The complaints policy is available in the service user guide and is clear and easy to understand. The manager said that all complaints received by the home are documented and placed in a complaints folder. Documentation seen on the day of inspection confirmed that staff had received training in safeguarding adults procedures and refresher training takes place every year. The home has an internal policy on safeguarding adults and this is in line with the local authoritys, and the home also has a copy of that procedure. Staff spoken to on the day were knowledgeable about the safeguarding procedures and what their responsibilities were. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home enables people who use the service to live in a safe and comfortable home where a maintenance and refurbishment programme is in place to improve the environment further . Evidence: A tour of the home took place and people who use the service were seen to be able to access all parts of the home and grounds. The home on the day of inspection was seen to be clean and tidy and free from offensive odours. All of the bedrooms are single and these were observed and seen to have been personalised by the people using the service. One lady was keen to tell us about the pictures and photographs on the wall. She told us she enjoyed the room as it was bright and sunny and overlooked the garden. The home has the main lounge where there is a television and also the library which is a quite room. The home employs a maintenance person and assistant and they are responsible for all routine repairs and decorating. There is also a housekeeper who the maintenance department report to.The AQAA advised us that urgent repairs are dealt with without delay. A maintenance record is kept and visitors to the home can write any problems into the book for their attention. During the last year two new baths have been installed and a new hoist Care Homes for Older People Page 18 of 26 Evidence: purchased.The manager has moved her office from the ground floor to the basement and this has meant another room is again available for use. The laundry was tidy and clean on the day of the inspection. Gloves, aprons, hand towels and liquid soap are all available and staff have received infection control training. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff numbers at the home on the day of inspection were sufficient to meet the assessed needs of the people using the service. NVQ training for the care staff continues to ensure a good skill mix of staff on duty. Evidence: The home benefits from an experienced staff team and when sampling the staff rota it was observed that staffing levels are consistent. The deputy manager told us that she does the rotas for the staff and that they always try to ensure that there is a a good skill mix. We were also told that the home does not have to use agency staff very often as empty shifts are often covered by the current staff team. One person using the service told us the staff are very kind to me. Another said the staff are good they do a lot for me. They always answer my bell when I need them. The manager said that well over 50 of the care staff have NVQ certificate at level two and that the training at the home is on going. Some members of staff have achieved the level three qualification also. The housekeeping team have also had NVQ training at level 2. Two staff employment folders were sampled and were found to have the necessary paper work to enable the home to employ those people safely. This ensures that the Care Homes for Older People Page 20 of 26 Evidence: people who use the service are protected by the homes recruitment procedures. One recruitment folder did not contain an explanation for a gap in the employment history. The manager and training manager are responsible for the interviews of all new staff. They were both aware of the reasons for the gap but these were confidential. A discussion took place with how to deal with this area of recruitment and they will attend to this following the inspection. We spoke with the training manager for the home. She told us that she provides some of the mandatory training for the home and the rest is given to outside training providers. Mandatory training includes safeguarding adults, infection control and first aid, manual handling and fire awareness. The home has a training matrix in place and all training that is required is documented for each member of staff and when their update is due. The training manager said that the mandatory training takes place at the home and the staff will be informed of the dates that they must attend. Staff spoken to on the day told us the home provides good training and up to date information is provided on a regular basis. Another told us we do have regular training and this helps us to understand our work. Specialist training has also been provided and this has included dementia awareness and customer care. On the day of inspection some staff were attending training on the Mental Capacity Act. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements at the home ensures the staff team is adequately supported and there are clear lines of managerial accountability. Quality assurance systems are in place which improve the quality of care offered to the people who use the service. Evidence: The registered manager was on duty on the day of inspection. She has been in post for two years and has achieved the registered managers award and NVQ at level 4. Since her appointment she told us that she has had to introduce a lot of changes and the staff had adapted well and supported her. On the day of the inspection it was observed that the home was running smoothly and the manager had a good knowledge of the needs and problems of all of the people using the service. The manager has introduced new systems for the ordering, storage and distribution of medications and this is now working well.The manager is supported by a deputy who is in charge when she is away. Care Homes for Older People Page 22 of 26 Evidence: The manager told us that surveys are sent to the people who use the service and their relatives/representatives to seek their views on the quality of the service and care provided. These surveys are sent out twice a year. An action plan is then written so that any shortfalls identified can be addressed. The manager said that the surveys allow them to implement changes quickly when a problem is identified. The manager also told us that Regulation 26 visits are carried out at the home every month by The Trustees. These are unannounced visits and they speak to the people using the service and often stay for lunch. A report is written on the findings and are then discussed with the manager and a copy available at the home for the inspector to see during inspection visits. We were told that some personal money is held by the home. The system was not sampled during this visit but the money is kept separately and receipts are kept and transactions all signed for. All necessary health and safety certificates are in place and we also observed a range of policies and procedures relating to health and safety. The housekeeper has responsibility for the health and safety of the staff and people using the service. All staff receive training in health and safety. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 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). 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