Care Home: Stokefield Care Home

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What the care home does well All people that wish to use service benefit from a pre-admission assessment and the care plans are then generated from this initial assessment. Care plans are clearly written and provide sufficient information to allow care staff to adequately care for the people using the service. The care plans are reviewed every month and are agreed with each person using the service. All food provided at the home is freshly cooked and the home uses fresh fruit and vegetables everyday and this was observed during the visit. The staff spoken to on the day were knowledgeable about the care needs of the people using the service. They were observed to be interacting and speaking appropriately to the people using the service in a calm manner. Activities take place regularly nd the home has an activities organiser. Large group activities take place, one to one activities for those who do not leave their room and trips are arranged out of the home. Regular training takes place and this includes the NVQ (National Vocational Qualification) which all staff have access to. Other training assist staff to gain an understanding in topics such as safeguarding adults, food hygiene and manual handling. The manager has been in post since 2003 and is supported by a deputy and a stable staff team. there are clear lines of managerial responsibilities. What has improved since the last inspection? Four requirements were made following the last inspection in June 2007 and these have now been met. All individual care plans are now reviewed every month. The home now has a copy of the local authority`s safeguarding adults procedures. The en suite showers in the identified bedrooms have now been assessed for their inaccessibility. Guidance was obtained from the fire officer as to the frequency of fire drills in the home. What the care home could do better: Four requirements were made following this key inspection. All care plans to be reviewed where standardised plans are used to ensure they have been personalised and adapted for the person using the service. The manager to adopt a complaints log which is kept confidential and shows the actions taken when investigating a complaint with timescales. The home`s internal safeguarding adults policy and procedure to be reviewed to ensure it matches that of the local authority`s. The numbers of staff on night duty should be reviewed due to the layout of the home. Key inspection report Care homes for older people Name: Address: Stokefield Care Home Stokefield Care Home St Johns Hill Road Woking Surrey GU21 7RG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lesley Garrett     Date: 1 1 0 6 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 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) 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 27 Information about the care home Name of care home: Address: Stokefield Care Home Stokefield Care Home St Johns Hill Road Woking Surrey GU21 7RG 01483761779 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: ann.duddridge@hanover.org.uk Hanover Housing Association care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 25. The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) ) Date of last inspection Brief description of the care home Stokefield care home is owned and managed by Hanover Friends. The service provides accommodation to 24 older people. The homes communal facilities are two sitting rooms and a dining room; the bedrooms are all single occupancy. Accommodation is provided over two floors, which is accessible by lift. The home has specialist bathing facilities and equipment. The care home is situated in close proximity to Woking town centre and local amenities can be accessed through the homes own transport or community transport. Parking facilities are provided at the front of the building Care Homes for Older People Page 4 of 27 Over 65 25 0 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of the care home was an unannounced Key Inspection. Mrs Lesley Garrett, Regulation Inspector, carried out this visit and the registered manager represented the service. We arrived at the service at 10:30 and were in the home for three and a half hours hours. The manager had to leave before completion of the inspection so we spoke with her the next day to clarify some points and to give feed back. It was a thorough look at how well the home is doing. It took into account information provided by the home and any information that CQC has received about the service. The manager for the service supplied CQC with an AQAA (Annual Quality Assurance Assessment) and this document was used to assist with the inspection. The inspector also spent time talking with some of the people using the service and staff members. Care Homes for Older People Page 5 of 27 We looked at how well the service was meeting the key national minimum standards and complying with the regulations and have in this report made judgements about the standard of the service. Documents sampled during the inspection included the homes care plans, daily records and risk assessments, staff files, training records, and the homes safeguarding and complaints policies and procedures. From the evidence seen by us and comments received, we consider that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: Four requirements were made following this key inspection. All care plans to be reviewed where standardised plans are used to ensure they have been personalised and adapted for the person using the service. The manager to adopt a complaints log which is kept confidential and shows the Care Homes for Older People Page 7 of 27 actions taken when investigating a complaint with timescales. The homes internal safeguarding adults policy and procedure to be reviewed to ensure it matches that of the local authoritys. The numbers of staff on night duty should be reviewed due to the layout of the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 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 9 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 who wish to use the service benefit from a pre-admission assessment from a suitably trained person from the home to ensure that the home can meet their needs. Evidence: We looked at the service user guide and statement of purpose and both of these documents had been reviewed this year. They contained all the information that that would allow people to make an informed choice about the home prior to moving in. The manager told us that people who wish to use the service benefit from a preadmission assessment from a suitably qualified person from the home. This is usually carried out by the manager, the deputy or a senior carer. The documentation used by the home for these assessments allow a through assessment to take place and care plans can then be generated from this documentation. The manager told us that some people wishing to use the service visit the home and they can stay for lunch or even Care Homes for Older People Page 10 of 27 Evidence: stay for the day to allow an assessment to take place. The home does not offer intermediate care. 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. The health and personal care that people using the service receive is based upon their individual needs, which is documented in their care plans. The people using the service also have support from healthcare professionals when it is required. Evidence: Two care plan folders were sampled and both contained detailed information about the person using the service. The care plans sampled allowed care staff to be able to care adequately for the people using the service as the information contained within this document was detailed. There was evidence that the care plans had been reviewed every month and that people using the service had also participated and agreed the plans. We spoke to the manager following the sampling of the care plans. The home uses some standardised care plans. This means that some information is on the care plan which is computer generated and staff then need to personalise this document. There are clear policies and procedures in place to explain to staff what the procedures are to adapt these documents. In some cases it was observed that staff had not fully Care Homes for Older People Page 12 of 27 Evidence: personalised these documents. The manager said that she would ensure that this piece of work is completed by the staff. The manual handling assessment also needs to be reviewed as the format used is more applicable to hospital settings. For example the document states that intra venous infusions and monitors may be a hindrance for manually handling this person but the home does not use these pieces of equipment.There will be a requirement at the end of the report for the home to ensure that the care plans have been personalised where required. The manager told us that the people using the service can retain their own local GP and that means the home has about four different surgeries visiting the home. The GPs will visit the home when requested by the staff or person using the service.. Opticians visit every six months and the chiropodist every six weeks. The district nurse also supports the home when requested to do so. The home has its medications delivered every month by a large chain pharmacy and this is dispensed in blister packs. We sampled some medication administration records and these were found to have no gaps. Policies and procedures are in place for staff that administer the medicines and also protocols for those people using the service that wish to self medicate. During the day staff were observed to knock on doors prior to entering and were using the preferred names of the people using the service as documented in their care plans. The AQAA told us that all people using the service are encouraged to live their life as they choose to do. There are en suite bathrooms available for staff to deliver personal care in the privacy of the persons own bedroom and healthcare professional visits take place in the persons bedroom. Care Homes for Older People Page 13 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. People who use the service have access to a varied activity programme which aims to meet all peoples needs. Menus are varied and offer choice and the dining arrangements offer a pleasant mealtime experience. Evidence: The manager told us that the home employs an activity organiser who works four afternoons a week. She also told us that these days could be flexible depending on the activities organised. On the day of inspection a notice board in the reception area detailed the activities arranged for that week. There was a range of activities on offer which included group and one to one sessions. Trips out in the mini bus are also organised and the manager said that these activities are also very popular. People who use the service told us that there is a variety of activities on offer and they can select those that interest them. One person said there is always something to do but I dont have to join in if I dont want to. Family and friends are welcome at the home at any time. Visiting is not restricted and people using the service can return to their bedrooms if they wish to see their visitors in private. One person using the service told us that her son had bought her some Care Homes for Older People Page 14 of 27 Evidence: patio furniture and she enjoyed sitting on her balcony with visitors as it was very peaceful. The manager said that local schools have visited at Christmas to sing Carols but they are not frequent visitors. She also told us that every month the local church arranges a service in the lounge for the people using the service. The home is also able to contact any other denominations if requested. It was observed during the inspection that people who use the service are offered choices on a variety of different topics. The manager told us that staff ask when people would like to go to bed and get up in the morning and the time they would like breakfast. Staff were observed to knock on the bedroom doors prior to entering. The home has a full time head cook and is supported by other cooks in the kitchen. The cook told us that she prepares all the meals from scratch using fresh fruit and vegetables everyday. She also told us that a four week menu plan is written in consultation with the manager. The head cook attends resident meetings and food is always discussed. People using the service spoken to on the day were complimentary about the quality of food. One person told us the food is lovely why dont you join us another said there is always a choice and if you dont like it you can have something else. During the inspection we observed the lunchtime service. The tables were laid with tablecloths and napkins. Drinks and menus were available on each table. People using the service were chatting to one another throughout the meal making the atmosphere in the dining room lively and welcoming. Care Homes for Older People Page 15 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 who use the service can be confidant that their complaints are listened to and that they should be protected from abuse as the staff team have received training in safeguarding adults. Evidence: The manager said that during the last year they had received one complaint that had now been resolved. The complaints book was seen and there was a reply to the complainant in the book from the manager. The manager logs all complaints in a book. A discussion took place about this practise as the book was not as clear as it could be as outcomes are not documented clearly only the response in the book by the manager. It was discussed that a complaints folder should be kept so that all concerns raised are kept confidential. This will be a requirement at the end of the report. The complaints procedure is available at the home and is also made available to all people who use the service and their representatives. During this inspection people using the service were asked if they knew how to complain and who to complain to and all said yes. The manager told us that the home follows the local authoritys procedures for the safeguarding of adults. Staff have access to these procedures and the homes own internal policy. This policy was observed and it does not match the local authoritys procedures so a requirement will be made for the management to review their internal Care Homes for Older People Page 16 of 27 Evidence: safeguarding policy to ensure that it matchs the local authoritys. Staff spoken to on the day confirmed that they had received training in safeguarding adults and the records also confirmed this. The home has a whistle blowing policy that staff also have access to. Care Homes for Older People Page 17 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 using the service live in a clean, comfortable and well maintained home and have access to attractive gardens. Evidence: We looked around the home and observed the communal areas and some bedrooms. All bedrooms at the home had been personalised and some people using the service were pleased to show me their rooms. All bedroom doors have locks and the keys are used by some people.One person told us they always lock their door but it is a bit of a nuisance remembering to take the keys every time they leave the room. One persons room observed had a door that lead out onto a private balcony. They told us the sunlight comes into the room during the summer making the room quite warm. This had been discussed with the manager who was organising a blind for the door. The manager told us that there is a programme of refurbishment and that so far this year the carpets had been replaced on the lower level. The communal areas were clean and bright and the communal bathrooms large and welcoming. The gardens are accessible and are well maintained. On the day of inspection people were seen to be sitting in the gardens in the shade enjoying the good weather. Hand towels and soap dispensers were available for staff for hand washing and aprons Care Homes for Older People Page 18 of 27 Evidence: for use during personal care. The home has a laundry room and documentation confirmed that infection control training had taken place No offensive odours were apparent on the day of inspection. 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. Staff in the home are trained and skilled and in sufficient numbers to support the people using the service. Recruitment practises are robust which should protect the individuals living at the home. Evidence: The home had a relaxed atmosphere and staff were observed to undertake their tasks in a quiet and orderly manner. We observed staff interactions with people using the service all of which were professional and supportive. The manager told us that she writes the staff rotas. The numbers appeared sufficient during the day to meet the assessed needs of the people using the service. The manager told us that the skill mix is always taken into account when looking at the rotas. During the night shift there are only two members of staff on duty. Due to the layout of the building it was discussed with the manager that the number of night staff available should be reviewed and a requirement will be made at the end of the report Comments received on the day were all positive about the staff in the home. One person said staff are nice, kind and helpful. Another told us the staff answer the bell when we need them they cant do enough for us. The manager said that most staff have now achieved the National Vocational Qualification (NVQ) at level 2 and two senior members of staff are currently Care Homes for Older People Page 20 of 27 Evidence: undertaking their level 3. Records sampled confirmed this and confirmed that this training is on going.All new members of staff have an induction and this is also linked to a national organisations common induction skills which links with the NVQ programme. Three employment folders for the staff were sampled. These folders confirmed that the home had in place all the necessary documentation to allow them to safely employ new members of staff. The training records for the home were observed and confirmed that mandatory training takes place. Staff confirmed that they receive regular training and this included safeguarding adults, health and safety, manual handling and fire awareness. Specialist training is also available which included Dementia. 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. Management arrangements at the home ensures the staff team is adequately supported and there are clear lines of managerial accountability. An effective quality assurance system has been developed. Evidence: The manager was in charge on the day of the inspection. She had an appointment to attend at lunchtime so further information was gathered by telephone the following day and feed back was given at that time. The manager has been in post since 2003 and has achieved her registered managers award. She has the support of a deputy manager in the home and regular visits from her line manager. The manager told us that she has an open door policy so that people using the service and relatives or representatives can speak to her at any time The manager told us that the home has a quality assurance system in place where the Care Homes for Older People Page 22 of 27 Evidence: views of the people using the service and their representatives are sought every year. All responses are kept by the home and negative comments can then be acted upon. The results of the most recent survey carried out this year was available at the home.We sampled these surveys and the comments in them were all very positive with people very complimentary about the service provided by the staff and the quality of the food. The manager told us that they hold meetings for the people using the service every three months and minutes are taken. The operations manager for the home visits every month and these visits are called Regulation 26 visits. Records of these visits are kept at the home and available for inspection. The home does not manager the finances for any people using the service. Some people do opt to leave money in the safe at the home and a record is kept of all transactions in and out. Documents sampled demonstrated that the home has the necessary health and safety certificates in place. Fire alarms are tested regularly and fire awareness training takes place for all staff. 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 7 15 All care plans to be reviewed 25/07/2009 where standardised plans are used to ensure they have been personalised and adapted for the person using the service. To ensure the care plans contain relevant information on each person using the service. 2 16 22 The manager to adopt a complaints log which is kept confidential and shows the actions taken when investigating a complaint with timescales. To ensure that any complaints received by the home are kept confidential. 25/07/2009 3 18 13 The homes internal safeguarding adults policy and procedure to be reviewed to ensure it matches the local authoritys. 25/07/2009 Care Homes for Older People Page 25 of 27 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 To ensure that staff receive training and have an understanding of one policy. 4 27 18 The numbers of staff available on night duty should be reviewed due to the layout of the home. To ensure there are adequate numbers of staff that can meet the needs of people using the service during a twenty-four hour period. 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 25/07/2009 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. If you would like a summary in a different format or language please contact our helpline or go to our website. 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