Care Home: Rutland Care Village

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What the care home does well The home is purpose built and is furnished and decorated to a high standard providing a homely and comfortable environment that meets the needs of people living at Rutland Care Village. Staff working at the home were helpful and professional throughout this inspection process. It was evident that staff felt well supported and were highly motivated to constantly improve the service provided. People spoken with praised the staff employed at the home and said they were treated with respect at all times. People spoken with felt able to make choices about their daily lives. What has improved since the last inspection? Since the last inspection more staff training regarding caring for people with dementia and safeguarding adults has been provided, this training was ongoing at the time of this inspection. A new unit manager has been appointed on Cottesmore Unit, staff on this unit have worked hard to improve outcomes for people living there and improvement work was ongoing at the time of this inspection. What the care home could do better: Policies and procedures for the safe management of controlled medication were being followed but staff did not always follow the correct recording procedures and therefore a requirement was made regarding this. Care plans were person focused and there was some evidence of people living at the service being involved in the care planning process, however this was not always the case. People must be given the opportunity to be involved in the care planning process so that the care they receive matches their expectations and preferences. Since the last Key Inspection, outcomes for people living on Cottesmore Unit had improved, this had been achieved through a change of unit leader and more staff training in caring for people with dementia. Improvement work was ongoing and staff were aware of the shortfalls we identified, these included staffing levels being too low at busy times of the day and the provision of meaningful activities for people with dementia. While there were activities on offer, people with dementia need occupation and engagement that is meaningful and appropriate to their individual needs, the unit leader was in the process of undertaking training in dementia care and the provision of meaningful activity was included in the course content. Some people living in the Cottesmore unit needed more assistance in selecting their choice of menu, this could be achieved through visual rather than verbal cues. Key inspection report Care homes for older people Name: Address: Rutland Care Village Huntsmans Drive off Barleythorpe Road Oakham Rutland LE15 6RP     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: Debbie Williams     Date: 0 7 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: Rutland Care Village Huntsmans Drive off Barleythorpe Road Oakham Rutland LE15 6RP 01572722350 01572725980 oakhamvillage@prime-life.co.uk info@prime-life.co.ukwww.prime-life.co.uk Prime Life Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Debra Crossfield Type of registration: Number of places registered: care home 82 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 82 The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Physical Disability - Code PD Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Care Homes for Older People 1 1 0 3 2 0 0 9 82 82 0 82 Over 65 0 0 82 0 Page 4 of 26 Brief description of the care home Rutland Care Village is a care home for older persons, providing nursing and personal care for up to 72 people, some of whom have mental health needs, dementia and/or physical disabilities. The home was purpose built in 2006 and is owned and managed by Prime Life Limited. The home is situated in the town of Oakham, Rutland. The home is close to the main road and is easily accessible by private or public transport. Rutland Care Village has three distinct units, which can accommodate up to 24 people, including a unit for people with dementia related conditions. All the units have a dedicated team leader and a team of care staff and there is a trained nurse on duty at all times to provide nursing care to nursing clients. Accommodation is provided on the ground floor. All bedrooms have en-suite facilities and a patio door leading to the landscaped gardens, which surround the home. A copy of the latest Inspection report is available at the home, or it can be accessed via the CSCI website: www.csci.org.uk. Further information about the home is available from the registered manager. 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: We visited the service on the 7th of October 2009 to carry out this key inspection. We case tracked five people living at the home and looked at their care records, spoke with staff about there care needs and observed care practices. We also looked at staff training records and spoke with staff about the training they had received. We also carried out a short observational focused inspection, this inspection helps us to assess the experience of people who have dementia, the quality of staff interaction, and the level of occupation and engagement experienced by people who have dementia. We looked at the providers Annual Quality Assurance Assessment (aqaa), this gave us information about what has happened at the service since the last key inspection. Care Homes for Older People Page 6 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. Care Homes for Older People Page 7 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 8 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 9 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 have access to the information they need to make an informed choice before moving in to Rutland Care Village. People have their needs assessed before moving in. Evidence: The provider sent us their annual quality assurance assessment (AQQA) and this contains information about the service. The AQQA states that people moving into the home are provided with the information they need and that this information is also available in different languages and in braille. Prospective residents are encouraged to view the home and to spend time at the home before making a decision. A trial period is then offered with a review clause in the contact of terms and conditions, this ensures that people are able to re evaluate their decision should they wish to. People have their needs assessed by a senior member of staff before moving into the home, this is to ensure that the service is suitable and can meet peoples needs. Care Homes for Older People Page 10 of 26 Evidence: We spoke with one person who had recently moved into the home but had not received the information described, during this inspection the registered manager arranged for this information to be provided. Other people spoken with told us they had received the information they required when moving in. We looked at assessment records and found that a full needs assessment was completed, information was also in place about peoples individual preferences, likes and dislikes and life history. This information is particularly useful for people who had or may develop communication difficulties and ensures that staff are aware of peoples individual needs and preferences. 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. People living at Rutland Care Village had their health and personal care needs met. Evidence: We looked at care plans and found they contained information about all assessed needs and provided staff with clear instruction about how to meet peoples individual needs and preferences. Care plans were person focused and also included all relevant risk assessments. We spoke with care staff who were able to demonstrate a good awareness of peoples needs. We made a recommendation that people be given more opportunities to be involved in their care plans, this would ensure that people do have their expectations met. People spoken with told us they could see their GP whenever they needed to. Care records also confirmed that people had access to appropriate healthcare services. There is a qualified nurse on duty at all times and the local community nursing team also visit people at the home. Care Homes for Older People Page 12 of 26 Evidence: We observed staff interaction with people living at Rutland Care Village and found that interactions were positive and respectful. People spoken with praised the staff employed and said they were always professional and respectful. We looked at medication management on two of the units. Only senior carers who have received training or qualified nurses were given the responsibility of managing peoples medication. We looked at storage areas and medication administration records and found them to be accurate and up to date. However, some administration records for controlled medication had not been kept up to date and there were some instances when second signatures had not been obtained despite this being required. Where medication is prescribed on an as required basis, it was recommended that a protocol be put in place so that staff are fully aware of when this medication should be given. 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. People living at Rutland Care Village are able to exercise choice and control over their lives. Evidence: People spoken with told us they were able to choose how to spend their day and that routines of daily living were flexible. Staff spoken with told us they were instructed to give people choice regarding routines of daily living. The home is divided into three separate units (Belvoir, Quorn and Cottesmore), each with its own lounge and dining areas. People could choose to spend time in the communal areas or in their own rooms and could take their meals in the dining rooms or in their own rooms. There is also a separate day care unit known as brambles. There were a variety of activities on offer at Brambles. On the day of this inspection many of the residents went to brambles to receive holy communion. We spoke with residents and their visitors. There are no restrictions on visiting and people told us their visitors were made very welcome. The providers were adhering to mental capacity and deprivation of liberty guidance. This means that in a situation where liberty is deprived in order to promote safety, Care Homes for Older People Page 14 of 26 Evidence: this is only done following consultation and agreement from the Leicestershire and Rutland Deprivation of Liberty team and is then regularly reviewed. People spoken with on Belvoir and Quorn said they were satisfied with the opportunities on offer for leisure and social activities and that they matched their expectations and preferences. We undertook a short observational focused inspection on Cottesmore unit. This type of inspection is designed to assess levels of wellbeing, interaction and engagement for people with dementia. We found that staff interaction during this inspection was positive but mainly occurred when staff were undertaking tasks such as providing meals or hot drinks. We made a requirement that people with dementia be offered meaningful activities that meet their individual needs and preferences. The unit leader was in the process of completing a course in dementia care and told us that the provision of meaningful activities for people with dementia would be part of this course. People spoken with told us they were satisfied with the quality and quantity of meals provided and their was always a choice available. One person told us they asked for a bacon sandwich which was not on the menu for that day and this was provided without any problem. There were kitchenettes in each of the lounges where people could access snacks or drinks. The lunch time meal served during this inspection appeared appetizing and nutritious. We made recommendations that people are not kept waiting at the table before their meals are served and that people with dementia are given more assistance in making their choice at meal times, this could be achieved by showing plated up examples of the meals on offer or by using pictures of meals on offer. Staff assisted people with their meals in a sensitive and professional way. People who required support were given one to one support and staff stayed with them until they had finished their meal. Dining rooms were congenial and the atmosphere was relaxed and unhurried. The home is a purpose built single storey building, each room has a patio door leading to the garden areas. Garden and outside areas were attractive, accessible and secure. There were two cats at the home and one person had brought their dog to live with them at the home. 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. People living at Rutland Care Village are confident that their complaints will be listened to and taken seriously. Policies and procedures in place for safeguarding people from harm promote safety for people living at the home. Evidence: People spoken with told us they would feel confident making a compliant and that staff would take appropriate action. The providers told us it was their policy to report all incidents and complaints to the local social services department. The service has a complaints procedure, one person spoken with had not received a copy of this, the registered manager arranged for a copy of the complaints procedure to be given to this person during this inspection. Staff had received training in complaints, whistle blowing and safeguarding vulnerable adults. We spoke with four staff members who were able to demonstrate a good understanding and awareness of complaints and safeguarding policies and procedures. This minimizes the risk of harm for people living at Rutland Care Village. 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 premises and environment were safe, homely and suitable for peoples needs. Evidence: The home is purpose built single storey building separated into three units and a day care unit. The registered manager told us that some redecoration and refurbishment was being planned as the building was now four years old. People living at the home were being consulted about their preferred colour schemes. An Environmental Health Officer had recently visited the home and all regulations were complied with. The fire alarm is tested weekly and staff are instructed to go to the assembly point when the alarm is sounded. Staff told us they had received training in fire safety and fire policies and procedures. All areas of the home seen were extremely clean, homely and decorated and furnished to a high standard. There were a choice of sitting areas. Outside areas were well maintained and accessible to people with disabilities. Peoples private rooms were personalized and people were able to bring in their own furniture if they wished to. Communal bathrooms were fitted with assisted baths and were also decorated to a high standard. Staff told us that people could have the lights dimmed, music and bubble bath in order to provide a relaxing bathing experience. Care Homes for Older People Page 17 of 26 Evidence: Staff had received training in infection control and this minimized the risk of cross infection for people living at Rutland Care Village. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing numbers and skill mix are mostly sufficient to meet peoples needs. Recruitment procedures promote safety for people living at Rutland Care Village. Evidence: We looked at staffing rosters and spoke with residents and staff about staffing levels and skill mix. People spoken with told us there were enough staff on duty and that they were trained and competent. On one of the units were people living there had high dependency needs, the unit leader told us they were introducing a new shift so that an extra staff member would be on duty form 6 am and until 10 pm, this is required in order to ensure sufficient staffing numbers at these busy times and to ensure people living there are offered the support they need. We looked at staff training records and staff files. A programme of staff training and development was ongoing. All mandatory training had been provided such as moving and handling and infection control. Many of the care staff had achieved a National Vocational Qualification in care. Training had also been provided in dementia care and safeguarding vulnerable adults. All new staff were provided with induction training. We looked at recruitment records and found that all necessary checks had been Care Homes for Older People Page 19 of 26 Evidence: carried out and at least two references obtained. This ensures that people working at the home are fit to do so and promotes safety for people living at the home. 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. The service is run in the best interests of people living their. Health, safety and welfare are promoted. Evidence: Staff had received the health and safety training they required to promote safety for people living at Rutland Care Village. We discussed the providers policy when people have a fall. People who fall are assessed by a trained first aider, medical attention is then sought if required. We recommended that the registered manager discuss this policy with the GPs that visit the home to ensure that it meets their requirements. We looked at the providers annual quality assurance assessment (aqqa) this provides information about what has happened at the home since the last key inspection. The aqqa told us that all catering staff had completed training in food hygiene and 69 of care staff had also completed this training. Care Homes for Older People Page 21 of 26 Evidence: The aqaa also told us that all routine checks and maintenance had been carried out, this ensures that the premises and all equipment used is safe and well maintained. The service is run by a registered manager who has the relevant skills and experience. People spoken with told us the felt supported by the management team and that they were approachable. An in house quality assurance and audit system was in place. The service is also audited by a company director. Quality assurance questionnaires are sent out to residents and relatives twice a year, this is to ensure that the service provided is of good quality and meets peoples expectations. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 12 16 Staffing numbers and skill mix must be sufficient to meet the needs and preferences of people living in the home. People living in Cottesmore unit should be able to make choices about how to spend their day and be able to participate in meaningful activities. 27/04/2009 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 9 13 The correct procedures must 10/11/2009 be followed for the management of controlled medication. This is to ensure the safe custody and administration of controlled medication. 2 12 13 Meaningful activities that meet individual needs and preferences must be offered to people who have dementia. This is so that people with dementia have opportunities for stimulation, occupation and engagement in recreational and social activities. 27/11/2009 3 27 18 Staffing numbers must be sufficient to meet peoples needs at all times. More staff are required on Cottesmore unit in order to meet peoples needs. 14/12/2009 Care Homes for Older People Page 24 of 26 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 This is to ensure that people have their needs met and are able to excersise choice over their lives at all times. 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 7 It is recommended that people living at Rutland Care Village have more opportunity to participate in the care planning process. Where medication is prescribed on an as required basis, it was recommended that a protocol be put in place so that staff are fully aware of when and in what circumstances this medication should be given. The providers should look at reducing the amount of time people who live in the Cottesmore Unit have to wait at the dining room table before the receive their dinner. The service should consider how they can help people in the Cottesmore Unit identify and understand what is on the menu through other means than verbal communication. The providers should check that their policy on managing falls is in line with GP requirements. 2 9 3 15 4 15 5 38 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). 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. 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