Care Home: South Cary House

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What the care home does well People rights to privacy and dignity are respected by staff. Visitors to the home are encouraged and made welcome by staff and are invited to attend events. Feedback from people living at the home were very complimentary about the standards of care and support afforded to them. The statement of purpose and brochure makes it clear that prospective residents from all sections of the community will be made welcome and their needs accommodated. People are able to continue to pursue their spiritual needs and this is supported by the homes staff. The homes equal opportunities policy is relevant to residents and staff and makes the value system of the home clear, that is to provide a safe environment for all who live and work there. All the people spoken to were very satisfied with the standard of the food served at the home. Individual preferences were known and catered for by care staff and the cook. People could choose to have their meals in the dining room or in their own rooms. The home has a clear complaints policy that residents and visitors are aware of. Policies and procedures are in place to protect residents from the risk of abuse, including staff training and robust recruitment policies. The home was clean, tidy and free from unpleasant odours.The home is maintained to an excellent standard. People are able to bring in furniture and personal belongings to personalise their private room. Resident and staff meetings have been held and the views of those living and working in the home are being taken into account by the manager. The relatives and people living at the home said the atmosphere at the home was warm, caring and friendly. Staff were observed to be courteous and appropriately friendly towards people. One person described staff as "excellent". People living at the home are seen as individuals and the home tries hard to accommodate their individual needs and characters. The home provides a good induction to all new staff to ensure that they are confident in their role and feel well supported. The majority of staff have attended all necessary mandatory training. Both of these areas ensure that staff can meet the needs of people living at the home. What has improved since the last inspection? At the last inspection three requirements were made. These have now all been addressed. What the care home could do better: The home should consider introducing a falls risk assessment particularly for those people who have or are at risk of falling. The home needs to amend the abuse policy .The home should consider displaying menus to ensure that people living at the home have an active choice about the food they eat. Inspecting for better lives Key inspection report Care homes for older people Name: Address: South Cary House South Street Castle Cary Somerset BA7 7ES     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Justine Button     Date: 2 2 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: South Cary House South Street Castle Cary Somerset BA7 7ES 01963350272 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : rory.garden@btinternet.com Mrs Christine Anne Garden,MR RODERICK FINLAY GARDEN care home 18 Number of places (if applicable): Under 65 Over 65 18 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 South Cary House is a large Georgian property located on the outskirts of Castle Cary. Residents accommodation is arranged on the ground, first and mezzanine floors. All residents? rooms have en suite facilities. A passenger lift and call system are provided. The home has been decorated and furnished to a high standard. There are attractive gardens that are accessible to residents. The homes current fees range from £480 to £560 per week The home is registered with the Commission for Social Care Inspection to provide accommodation for up to eighteen residents over the age of 65 years who require assistance with personal care. The Registered Providers are Mr and Mrs Garden. Mrs Garden is also the Registered Care Homes for Older People Page 4 of 27 Brief description of the care home Manager. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: This Key unannounced inspection was carried out over one and half days by one inspector. The Manager Mrs Garden was available on the second day of the inspection. We would like to thank the manager and the duty staff for their time and hospitality shown to us during the visit. The focus of this inspection visit was to inspect relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are:excellent, good, adequate and poor. These judgment descriptors for the seven chapter Care Homes for Older People Page 6 of 27 outcome groups are given in the report. Records examined during the inspection were care and support plans as part of the case tracking process, medication administration records, maintenance records, the homes Statement of Purpose, staffing rosters, menus, the homes complaints file, staff recruitment files, staff training records, quality assurance processes and staff supervision records. The inspector also conducted a tour of the premises. Prior to the inspection we asked the home to completed an Annual Quality Assurance. (AQAA). This was completed to a good standard and submitted on time. In addition we sent out surveys to people living at the home. Nine of these were returned to us. The comments in these surveys have been included in the report. What the care home does well: What has improved since the last inspection? What they could do better: The home should consider introducing a falls risk assessment particularly for those people who have or are at risk of falling. The home needs to amend the abuse policy . Care Homes for Older People Page 8 of 27 The home should consider displaying menus to ensure that people living at the home have an active choice about the food they eat. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. 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 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wishing to move to South Cary House receive adequate information about the home to help them to decide if it is the right place for them. Everyone has their needs assessed before they move in to ensure that the home is able to meet their specific needs and expectations Evidence: The home has a colour brochure, service user guide and statement of purpose that enables people to gain information about the home before making any decisions about moving in. People spoken with during the inspection said that they or their representative had visited the home before they moved in. One person said that they had stayed for two weeks respite to get the feel of the place before they decided to move in on a permanent basis. This information was confirmed in the surveys received. Care Homes for Older People Page 11 of 27 Evidence: Everyone wishing to move into the home has their needs fully assessed by a senior member of staff, this ensures that the home is able to meet their needs. The home also obtains copies of assessments carried out by other professionals. Copies of assessments were seen in care plans. A copy of the terms and conditions of stay were viewed. These stated that fees are reviewed at the beginning of April each year and shall remain unchanged unless four Weeks notice is given. The contract stated that accommodation, food, heat, light care and personal laundry are covered in the fees. The individual shall from their own resources provide medical requisites (other than medication by prescription), hairdressing, newspapers, telephone calls, dry cleaning, clothing, or any other items of a luxury or personal nature. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to healthcare professionals according to their individual needs. Medication policies and procedures promote safe practice. Evidence: Three care plans were viewed during the inspection. All had been personalised to the individual and contained clear information about the person and their needs. There was very clear information about personal preferences and lifestyle choices . Assessments are carried out in respect of physical health such as nutrition, skin care and moving and handling. Specialist equipment is made available where required. Records of personal weights are maintained and referrals are made to appropriate professionals where there are significant losses or gains. One person at the home had recently had a fall. The home however does not have a falls risk assessment in place. This is recommended. Records are kept of all appointments with outside healthcare professionals. People living at the home said that they were able to see GPs, District Care Homes for Older People Page 13 of 27 Evidence: Nurses and a Chiropodist at the home. One person had recently been referred to a Community Psychiatric Nurse to seek advice to ensure that staff at the home were able to appropriately support the person. The home uses a Monitored Dosage System for medication. There is appropriate storage for medicines including those that require refrigeration. Only senior staff administer medication and they have all received training in this area. Medication Administration Records were viewed. These were well maintained and correctly signed when administered or refused. All medication is signed into the home to ensure a clear audit trail. Records of controlled drugs sampled correlated with stocks held at the time of the inspection. The home carries out a comprehensive monthly audit of medication to ensure safe practice is maintained. People spoken with during the inspection said that their privacy was respected and they were treated with dignity. Feedback included the staff are smashing this is the best place to live if you can not live at home. People said that they were free to spend time in the communal areas of the home or in the privacy of bedrooms. It was observed that staff knocked on doors before entering and post was delivered to people unopened. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are no strict routines in the home and people are able to make choices about how, and where, they spend their day. Visitors are welcome at anytime. Meals are of a good standard Evidence: The Annual Quality Assurance Assessment (AQAA) demonstrates that the manager has a commitment to listening to people who live and the home and providing choices for everyone. People living at the home said that they are able to choose what time they got up, when they went to bed and how they spent their day. It was clear that activities in the home are very person centered. One gentleman enjoyed gardening and so had been given part of the garden to complete this. One lady was seen completing a jigsaw a number of other people went out in either the garden or local village to enjoy the fresh air. One person went out to lunch with their family. Social and recreational events are Care Homes for Older People Page 15 of 27 Evidence: organised by the home including trips out and entertainment in house. Everyone asked said that they were able to have visitors at any time and that visitors were made welcome by staff . The home operates a four week menu. People living at the home described the food as traditional English however some people stated that they occasionally had a curry or sweet and sour. Specialist diets can be provided for although this is not applicable at this time. There is not a choice of food at the lunch meal. People stated that you did not know what you are getting until the meal is served. People stated that staff knew what you liked and what you did not like and an alternative was always provided. A list of likes and dislikes for each individual was seen in the kitchen. People stated that the food was always excellent. It is recommended that in order to promote choice that the home display a menu on a daily basis. This would allow people living at the home the opportunity to request an alternative meal of their choice in advance. There is a large pleasant dining room where most people eat meals. The main meal of the day is served at mid-day. Sherry or wine was offered to everyone prior to the meal. The main course of the meal is served plated. The meal was Shepards pie with a range of vegetables. The meal looked and smelt appealing. Cheesecake or Fruit and cream was served following the main meal. Yoghurts were also available. All meals are home cooked including all cakes and puddings. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are able to discuss any worries or concerns with the manager or a member of staff. Appropriate systems are in place to minimise the risk of abuse to people who live at the home. Evidence: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. One sentence in the abuse policy requires amendment. The policy implies that staff would commence an investigation into any allegations of abuse. This should not always be the case. Where a serious incident of abuse has been identified no investigation should be commenced until advise has been sought from the police. The manager agreed to amend this Staff have received training on issues of abuse and all asked were aware of the whistle blowing policy and the ability to take serious concerns outside the home. People living at the home said that they would be comfortable to approach the manager or a member of staff if they had any worries or concerns. All felt that they would be listened to and action taken to address any issues. Care Homes for Older People Page 17 of 27 Evidence: The complaints procedure is displayed in the entrance hall. No complaints have been received since the last inspection. There is a robust recruitment procedure which minimizes the risks of abuse to people living at the home. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. South Cary House provides a comfortable homely environment for the people who live there. Standards of cleanliness throughout the building are excellant. Evidence: South Cary House is a large grade 2 listed building with plans to extended to provide accommodation additional accommodation. It is set in immaculate extensive grounds with outside seating for people living at, and visiting, the home. All areas are fitted with a call bell and fire detection system. There are communal lounges and dining room which again are immaculatly maintained. A sample of bedrooms was viewed. Bedrooms vary in size but all seen were well furnished and decorated. People asked were happy with their personal rooms and it was noted that people could personalise their rooms with small items of furniture, pictures and ornaments. This gives rooms a homely individual feel. Bedrooms have en suite facilities and there are communal bathrooms and toilets around the home. Care Homes for Older People Page 19 of 27 Evidence: To assist people to maintain independence various aids and adaptations have been fitted throughout the home, these include hand-rails, a passenger lift and assisted bathing facilities. It was observed that some bedrooms had aids and equipment to meet the specific needs of the individual. The home has a laundry which is appropriate to the needs and size of the home. To promote good infection control practices hand washing facilities are available throughout the home. All areas seen were clean and fresh and people spoken with were happy with the standard of cleanliness throughout the home. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 are supported by a well qualified and competent staff team. There is a robust recruitment procedure that minimises the risks of abuse to people who live at the home. Evidence: The home employs 17 care staff. A number of the care staff have or are undertaking a National Vocational Qualification (NVQ) in care at level 2 or above. In addition to care staff there is a group of ancillary staff such as cooks and cleaning staff. All staff undertake a thorough induction programme when they begin work at the home and complete some shadow shifts. To ensure that care practices are safe and reflect current good practice all staff receive regular training in health and safety issues and training specific to the needs of the people who live at the home. One member of staff commented that they had excellent training opportunities that enabled them to gain knowledge and take on additional responsibilities. On staff member stated the home has a family atmosphere and standards of care are very high with a good emphasis on person centered care. The staff member went on to describe the training that she had undertaken. The recruitment files of 2 recently employed members of staff were viewed. These Care Homes for Older People Page 21 of 27 Evidence: gave evidence of a robust recruitment procedure which included checking people against the Protection Of Vulnerable Adults (POVA) register, obtaining written references and undertaking an enhanced Criminal Records Bureau (CRB) check. The staff turnover at the home is very low and as a smaller home all the staff are known well by the people living at the home. The homes AQAA stated From our quality assurance questionnaire Jan 09 all residents found staff to be helpful and attentive to there needs. I have nothing but praise for them. Helpful and understanding. I have no complaints and enjoy the fun that goes on here, the girls keep me happy. These finding were confirmed by the surveys received by us and with discussions with people on the day of the inspection. Generally staff and people living at the home felt that there were good numbers of staff on duty at all times. People said that they received the physical assistance that they required and that call bells were answered promptly. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is effectively managed taking account of the views of the people who live and work there. To promote the health and safety of people living and working at the home the building is maintained to a good standard and all equipment is regularly tested. Evidence: The registered manager of the home is Mrs Christine Garden (Mrs Garden also owns the home with her husband). Mrs Garden has completed the Registered Managers Award (NVQ Level 4) and has many years experience of working with older people. In addition the deputy manager has completed an NVQ 4 in care. Throughout the inspection the manager and senior staff demonstrated that they keeps thier knowledge up to date. The home has a commitment to ongoing learning. Prior to the inspection the manager completed an Annual Quality Assurance Care Homes for Older People Page 23 of 27 Evidence: Assessment which gave clear information about the home and showed that the home is committed to ongoing improvement. Policies and procedures within the home are regularly reviewed and up dated where appropriate. There are various systems in place to audit the quality of care and ensure that any changes made are in line with good practice guidelines and the wishes of people living at the home. There are annual questionnaires to seek the views of people living at the home and other interested parties. Results of the most recent questionnaires demonstrated a high level of satisfaction with all areas of the service. There are also regular meetings for people living and working at the home. People spoken with said that these are an opportunity to make suggestions and voice their opinions as well as information sharing. Both staff and people living at the home stated that the owners Mr amd Mrs Garden were very approachable and took and interest in what they were doing. To ensure the health and safety of people at the home the building is maintained to a good standard and equipment is regularly tested and serviced. Staff receive training in health and safety issues and records demonstrate that refresher training is undertaken by all staff to ensure safe working practices. The home does not act as a power of attorney or financial appointee for anyone living there. Up to date certificates of registration and insurance are displayed in the home. Care Homes for Older People Page 24 of 27 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 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 2 7 15 Itis recommended that the home develop a falls risk assessment It is recommended that the home display an menu in order that people living at the home can make an active choice with regard to the meal served. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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