Care Home: Spencefield Grange

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What the care home does well People living in the home are complimentary about the staff team and the way that they are looked after. They also like the `atmosphere` of the home. One person told us "staff are exceptionally good", another person told us "this place feels like my home". Staff have time to speak to and engage with people living in the home. We saw staff speaking to residents as well as singing and dancing with them. All sixteen people who responded to our survey said that staff were always or usually available when they needed them. People are very complimentary about the food, one person describing it as "exceptionally good" and another saying that they get fed well. The service also makes good provision for people who have special dietary needs because of cultural or health reasons. People are asked for their opinions about how the service is run and what they would like to see change. This is done through questionnaires, formal meetings and informal chats with managers and the Directors of the company. People can raise concerns about the service and they are investigated thoroughly. All sixteen people who responded to our survey said that they was someone they could speak to informally if they were not happy. What has improved since the last inspection? The Staff, Managers and Directors of the service have worked hard to address the requirements and recommendations made at the last key inspection of the service. Clear written information is recorded about how risks to residents` health and safety should be managed. Residents` written assessments of need have been reviewed and updated to reflect their current needs Care plans have been reviewed and give information about how residents` needs should be met. The opportunities for all residents, including those with dementia, to engage in activities and social interaction has been reviewed and improved. Staffing levels allow for greater opportunities for interaction between staff and residents as well as more formal and informal activities. Staff have received additional training and supervision to make sure that residents who require support to eat and drink and to obtain a nutritionally balanced diet are given that support. Staff have received training in conditions associated with mental ill health and the implications of the mental capacity act. This helps them to understand how to support and care for people with conditions associated with mental ill health. What the care home could do better: The registered person must make sure that they obtain two written references for each staff member before they start work in the home. The registered person should review the current system of recording residents` health care appointments, tests and investigations. This is so it is clear when each person has received any kind of health care intervention, and that staff are clear about any follow up action they should take, and when. Key inspection report Care homes for older people Name: Address: Spencefield Grange Davenport Road Leicester LE5 6SD     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: Ruth Wood     Date: 2 5 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Spencefield Grange Davenport Road Leicester LE5 6SD 01162418118 01162418118 Debbie@hicare.co.uk www.hicare.co.uk HiCare Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Deborah Crawford Type of registration: Number of places registered: care home 63 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 63 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Mental Disorder, excluding learning disability or dementia - Code MD Old age, not falling within any other category - Code OP Physical Disability - Code PD Date of last inspection Brief description of the care home Spencefield Grange provides accommodation for up to 63 people and is owned by Hicare Limited. It is located in a quiet suburb on the outskirts of the city of Leicester Care Homes for Older People Page 4 of 27 0 4 0 3 2 0 1 0 63 63 0 63 Over 65 0 0 63 0 Brief description of the care home and has access to a regular bus service. The building is a modern purpose built service offering accommodation on ground and first floor level. Bedrooms on the first floor are accessed by a shaft lift. There is ample car parking to the front and side of the home. At the rear of the home there is an extended patio terrace with garden furniture and ornate water fountain. The garden has level access for people with impaired mobility. There are suitable facilities to support people with physical disabilities such as handrails. Specialist equipment for the prevention of pressure sores is also available through the district nursing service. A copy of the most recent inspection report is available in the reception area. Information about current fee levels should be obtained from the registered 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: 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: Two inspectors visited the service on 25 May 2010 between 09:30 and 15:30. We spoke to people who live in the home and asked them about the kind of care they receive and what it is like to live at Spencefield Grange. We also spoke to relatives visiting the home and to staff members about their knowledge of peoples needs, their experiences of training and their understanding about how to protect people in their care. We looked at four peoples care records and spoke to the managers and Directors of the home about how these had been updated. We looked at medication records and staff recruitment, training and supervision records. We also looked at the record of Complaints and the way that the service responds to any concerns raised. We spoke to one of the homes activities organisers about how she ensures there is a varied programme of activities that meets the needs of the people living in the home. Care Homes for Older People Page 6 of 27 In addition to the inspection visit, this report has also been informed by the information sent to us by the service, in response to requirements from the previous key inspection and by meetings with Directors and managers of the service, who have kept us informed of their response to things happening in the home and the changes they have been making. We received sixteen responses from people living in the home to our Have Your Say surveys, which ask people to comment on the quality of care, food and range of activities available. We also received five response from relatives of people living in the home. Information from these surveys has been included in the report. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? The Staff, Managers and Directors of the service have worked hard to address the requirements and recommendations made at the last key inspection of the service. Clear written information is recorded about how risks to residents health and safety should be managed. Residents written assessments of need have been reviewed and updated to reflect their current needs Care plans have been reviewed and give information about how residents needs should be met. The opportunities for all residents, including those with dementia, to engage in activities and social interaction has been reviewed and improved. Staffing levels allow for greater opportunities for interaction between staff and residents as well as more formal and informal activities. Staff have received additional training and supervision to make sure that residents who require support to eat and drink and to obtain a nutritionally balanced diet are given that support. Staff have received training in conditions associated with mental ill health and the implications of the mental capacity act. This helps them to understand how to support Care Homes for Older People Page 8 of 27 and care for people with conditions associated with mental ill health. 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. 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. Accurate information about the homes services is available to enable people to make an informed decision about living at Spencefield Grange. Assessment procedures are in place to ensure that peoples needs can be met by the service. Evidence: The service users guide has been updated and now accurately reflects the accommodation and services provided at Spencefield Grange. The assessments of the people whose care that we looked at in detail, have been reviewed and updated to reflect their current needs. Care Homes for Older People Page 11 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. Peoples care plans outline how their needs should be met and how identified risks should be managed. Staff meet peoples needs effectively. Evidence: Since the previous key inspection on 23 November 2009 the care plans and risk assessments of all the people living at Spencefield Grange have been updated. We casetracked four people; this involved looking at their care and how it is met in detail by reading their care plans and risk assessments, speaking to two of them directly about how their needs are met and speaking to staff about the care that they give and how they obtain the information they need to care for people consistently. We also spoke with other people living in the home about how they felt their care needs were met. All four people had an up-to-date care plan reflecting their current needs. Some additional work is required on the risk assessments associated with each plan but this Care Homes for Older People Page 12 of 27 Evidence: is being addressed. The four staff we spoke to displayed a good understanding of peoples needs, how they should be met and where to obtain information about how to do this. Staff were also aware of the detail of peoples needs, such as how they like their toiletries arranged when receiving personal care. We also received sixteen Have Your Say surveys from people living in the home; twelve people said that they always or usually receive the care and support they need with four people saying that they sometimes do. People also made additional comments about the the way staff care for them on the day of the inspection and in their survey responses: They keep me clean, well fed and happy to be at the home at all times. Staff treat residents with respect and understanding. Staff are brilliant - they are wonderful people All staff receive training in moving and handling which is regularly updated. We directly observed staff using a hoist to move one person living in the home; staff transfered the person safely and competently and reassured the person throughout the process, making them smile. The service has been keeping us regularly updated since the previous key inspection about how it has been addressing requirements and meeting the needs of service users. They have liaised with outside professionals such as the Community Matron and the Community Dietician to meet the needs of a person who was experiencing regular falls and to meet the needs of people at risk of poor nutrition. Discussions with the registered manager and examination of peoples care plans demonstrated that people do have access to a range of medical services such as GPs, chiropodists, opticians and dentists. The way that these appointments are recorded does not always allow anyone reviewing the persons care plan to easily ascertain if and when they have received a certain treatment or intervention and if any follow up action is required by the home. We have therefore recommended to the service that it review the way that health care appointments and interventions are recorded, together with the procedures for following up results, if required. We looked at the medication records for the casetracked people and the way that medication is stored and managed, including medication that is controlled. There were no errors in the records that we examined. One senior staff member per shift, is now responsible only for administering medication; this means that they are not distracted by other duties. The service has purchased an additional medication trolley allowing Care Homes for Older People Page 13 of 27 Evidence: for better storage and easier administration. Controlled medication is being stored, recorded and administered correctly. Throughout the inspection visit we observed that staff spoke to people living in the home in a respectful manner. We did not observe any practices that compromised the dignity of anyone living in the home. All sixteen people who responded to our survey said that staff always or usually listen to and act on what they say. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs for social activities are met. People enjoy good food in pleasant surroundings and receive appropriate support from staff to eat their meal, if and when required. Evidence: The service has worked very hard to address the concerns identified at the previous key inspection in relation to people receiving appropriate support to eat their meals, if they require this. All staff have received training in this area and have been observed by managers to ensure their ongoing competency. One senior staff member is now in charge of the dining room at meal times and the registered manager told us that she is making frequent observations to ensure that people who need support, receive it and that everyones dining experience is pleasurable. We observed lunchtime as part of the inspection visit and saw that people who needed support received it. Lunchtime appeared to be a pleasurable experience for people. People we spoke to and those that responded to our survey were complimentary about the food in the home; food is exceptionally good., We get good meals, They feed you well Care Homes for Older People Page 15 of 27 Evidence: During the inspection we spoke to visitors who had come to see people living in the home. They confirmed that they were always made to feel welcome. This view was confirmed in the responses to our survey to relatives and friends of people living in the home, The staff are very welcoming and courteous. The service has employed another activities organiser (there are now two activities organisers) who works at the weekend as well as during the week. Current staffing levels also allow care staff to be more involved in spontaneous activities and to spend more time with people. During the inspection we observed that staff spent time speaking to people, sang and danced with them and organised impromptu ball games. The operations manager also spoke to us about how they are trying to introduce an activity or interaction with people just before mealtimes, so that they are more alert when they are eating their meal. We spoke to the activities organiser about the planned activities programme which includes a film club, flower arranging, bingo and arts and crafts. The organiser is also aware that some people need more individualised activities. For example one person likes to play dominoes in their room, another likes to read the newspapers and talk politics. She told us that every morning she goes to each person to find out what, if anything they would like to do. The service was hoping to acquire a new, larger minibus within the week of the inspection visit and a series of outings has been planned for the summer months. 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. Current practice in the home ensures that peoples concerns are listened to and that they are protected. Evidence: The complaints procedure is outlined in the service users guide. Ten of the sixteen people living in the home who responded to our survey, said that they knew how to make a formal complaint; all said that there was someone available for them to speak to if they were not happy. The homes complaints record verifies this as peoples concerns about such things as the way food is cooked or the behaviour of other residents are logged, together with details of a full investigation and the response made to the complainant. This demonstrates that people feel comfortable to raise concerns and that they are dealt with seriously by the home. All five relatives who responded to our survey said that they knew how to make a formal complaint and that the home had responded appropriately to any concerns raised. We spoke to four staff members about their understanding of protection and abuse. All staff said that they had received in-house training in this area, were able to recognise different types of abuse and knew how they should respond to ensure people living in the home were protected. The services response to recent safeguarding allegations also demonstrates that they are aware of the correct procedures to follow to ensure that people are kept safe. Care Homes for Older People Page 17 of 27 Evidence: The registered manager gave us a list of dates showing when all staff members would be taking part in external training in safeguarding, run by the local authority. Training has also been arranged for staff in the implications of the Mental Capacity Act and in the Deprivation of Liberty Safeguards. This training should consolidate staffs knowledge of how to ensure that people and their rights are protected. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and comfortable environment that meets their needs. Evidence: The physical environment is regularly monitored by managers to ensure that decor, furniture and equipment is in good repair. The company has a full-time painter and decorator that works in the companys two care homes and has been involved in the refurbishment of all the bedrooms in the home. We looked at the bedrooms of those people whose care that we looked at in detail; they were clean, in good repair and reflected the personalities and interests of the people living in them. The main lounge has been redecorated since the last inspection, and the seating has been moved around. This makes it easier and safer for residents when coming into the lounge, and gives staff more room to bring in hoisting equipment. On the day of the inspection visit, the home was clean and fresh smelling throughout; all the people who responded to our survey said that the home is always or usually fresh and clean. Staff have received training in infection control and there are separate laundry, domestic and kitchen staff who are not involved in the personal care of the people living in the home. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive effective support from appropriately trained staff Evidence: Staffing levels have been reviewed at the home since the previous key inspection and a management team from the companys headquarters is also working within the home. We observed at the inspection visit that staff members had time to speak to residents and could respond to their requests for assistance quickly. All sixteen people who responded to our survey said that there were always or usually staff available when they needed them. People were very complimentary about the staff, one person described them as exceptionally good. Staff said they had much more time now that staffing levels had improved to do activities with residents and to talk to them. Since the previous key inspection, all staff have had a review of their training in dementia care and have had their practice observed in key areas, such as helping people to eat. They have also received training in some mental disorders and training is taking place in understanding the implications of the Mental Capacity Act and the Deprivation of Liberty Safeguards. We looked at four staff members recruitment records. Each person had completed an application form, giving their employment history, and Criminal Records Bureau checks and evidence of identity were in place for each person. Two written references Care Homes for Older People Page 20 of 27 Evidence: had been obtained for three of the staff but were not in place for one staff member. The Director of the Company who facilitated the inspection explained that the person had been employed through an agency who they believed to have supplied the required documentation. They gave assurances that these documents would be obtained as soon as possible. Care Homes for Older People Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being managed in the best interests of the people who live there. Evidence: Hi-Care, the parent organisation for Spencefield Grange have responded robustly to the concerns raised at the previous key inspection on 23 November 2009. A management team from their head office continues to work alongside the registered and deputy manager. All requirements made at the key inspection have been addressed and the feedback from people who live, work and visit the home, (including health and social care professionals) is that peoples care needs are being met. The management team continues to monitor the service, seek the opinions of people living and working there and look for ways to improve how the service is run. For example an administrator has been appointed to free up some of the managers time so that she can spend more time on the floor observing practice and engaging with the people living in the home. Care Homes for Older People Page 22 of 27 Evidence: Minutes of meetings held with people living in the home have been forwarded to the Commission and these show that people are being asked for their opinions about how the home is run and that changes are being made, for example to the activity programme, in response to peoples requests and ideas. Staff confirmed that they are receiving regular supervision and observation sessions where their practice in a particular area is observed by a manager to ensure that they remain competent in this area. An up-to-date fire risk assessment is in place and staff have received training in fire safety in addition to other statutory training such as moving and handling and health and safety. Care Homes for Older People Page 23 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 24 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 1 29 19 The registered person must 09/07/2010 ensure that two written references are obtained for all staff before they commence work in the home. This should include, where applicable, a reference relating to the persons last period of employment, which involved work with children or vulnerable adults, of no less than three months duration. This is to protect people living in the home. 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 8 The registered person should review the current system of recording residents health care appointments, tests and investigations. This is to ensure that it is clear when each person has received any kind of health care intervention and that staff are clear about any follow up action they Page 25 of 27 Care Homes for Older People 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 should take and when. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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