Care Home: The Hermitage

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What the care home does well Several users spoken to confirmed that they had enough information about the home to make a decision of moving in here. A user, admitted for respite care provided many comments about the home and explained her admission. She was invited to the office and the manager explained to her all she wanted to know. Admission information was mainly collected from documentation, especially when users were coming in from far away. The home then conducted the assessment during the first trial week. The atmosphere in the home was impressive. The users, many of whom were only affected by the frailty of the older age, were communicative, cheerful and visibly enjoyed living in the home where the care was so well organised. A user responded to the question of the number of staff per shift: "It does not matter how many of them are here when they are so well organised. They are always here for us." She insisted: "They should be an excellent home, no doubt. You must give them excellent". Food and hygiene inspectors rated the home as a 5 star, excellent home for the second year in row. Staff satisfaction and commitment were confirmed by three staff members spoken to: "We work very much as a team. We even socialise outside the home and this helps maintain an excellent atmosphere in the home." A user of the service was laying the tables in the dining room and reacted when she saw us: "Oh, dear, I hope this is OK, I love doing this, you are not going to stop me, are you?", showing that she was aware of the other homes where these activities of service users would cease, but not here, where all users were encouraged to continue with their normal activities and remain as independent as possible. Another service user explained why she chose this home: "It does not smell of old people, this is like a 5 star hotel and staff treat us better than a hotel staff would do." Good, strict recruitment pracices, good and regular training and open and transparent management that expressed initiative to review and further improve the service also showed and explained why the users were so happy, safe and well looked after in this home. Staff all looked very smart in their white top uniforms and service users appreciated this extra element: "They (staff) are always smart and cheerful and we can rely on `our ladies in white`." What has improved since the last inspection? The home was continually providing very good service since the last inspection, through the Annual Service Review and up to this inspection, addressing all areas that needed to and could be improved, thus deserving an excellent rating. Having 2 NVQ assessors working in the home, the percentage of NVQ trained staff significantly exceeded the 50% expectation. The previous inspection addressed some potential improvements and the manager reported: "Recording medication brought forward was not necessary, as we prefer to audit old medication sheets too, thus ensuring that all medication procedures were consistently followed. When signing money records was offered to service users, they became confused and asked for the existing system to stay in place, as they felt very comfortable with it." Currently, the manager was in discussion with the owners of how to reduce thetemperature in the medication room. One of the options she mentioned was to insall an air-conditioning unit. What the care home could do better: Although the home was now rated as excellent, there were a few things that still could improve. Some better consistency in writing care plans was needed, where allergies that some users suffered from, could be written in front of the file. Care plans were generally good documents and contained clearly assessed needs and the way for staff to work to help users achieve their goals. But, a little addition could even better explain how staff supported and cared for the users: when the home helped users with their finances and with their medication, the plans should address what is happening for each user. These details were in the medication folder, but clarifying these actions in a summarised part of the care plans would make them even more inclusive. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Hermitage 6-12 St Mary`s Street Whittlesey Cambridgeshire PE7 1BG     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: Dragan Cvejic     Date: 3 0 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 24 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 24 Information about the care home Name of care home: Address: The Hermitage 6-12 St Mary`s Street Whittlesey Cambridgeshire PE7 1BG 01733204922 01733350041 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) : Mr Peter John Thory care home 24 Number of places (if applicable): Under 65 Over 65 24 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 The Hermitage is a privately owned care home providing personal care and accommodation for up to 24 older people. Accommodation is provided in 16 single and 4 shared bedrooms. Whilst service users may have a range of physical disabilities, such as the need for wheelchairs, the home does not offer specialised care for people with dementia. The home is situated in the centre of Whittlesey, within easy reach of the shops and local library. The main entrance opens onto a large car park; a second entrance opens onto St. Marys Street. The home is on two floors, with communal rooms and some bedrooms on the ground floor. Other bedrooms are on the first floor, which is accessed by a shaft lift or stairs. Staffing is provided by a team of care staff who are supervised by the manager and her deputy. Staff are on duty overnight to provide assistance to those who need it. The fee is presented in their information pack. . Care Homes for Older People Page 4 of 24 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 Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means the people who use this service experience excellent outcomes. After reviewing the service through annual service review on 28/04/08, the home continued to provide very good service for people that were cared for and supported in the Hermitage. We constanly monitored the service through reporting activities. The owners were sending reports of their regular visits. The home conducted a self assessment of their services and provisions and reported to us on the AQAA, Annual Quality Assurance Assessment form. Details from these documents are incorporated in this report. We visited the home on 30/04/09 and spoke to nine people living there and to three Care Homes for Older People Page 5 of 24 staff. We case tracked three people: users of the service. This means we checked the information about them contained in records, care for them at the time of visits was observed, and we collected comments from some of them and from other users of the service and from a hairdresser. We attended staff handover and observed care practices in the home, checked the environment by walking through the home, checked money and medication records and talked to the manager. What the care home does well: What has improved since the last inspection? The home was continually providing very good service since the last inspection, through the Annual Service Review and up to this inspection, addressing all areas that needed to and could be improved, thus deserving an excellent rating. Having 2 NVQ assessors working in the home, the percentage of NVQ trained staff significantly exceeded the 50 expectation. The previous inspection addressed some potential improvements and the manager reported: Recording medication brought forward was not necessary, as we prefer to audit old medication sheets too, thus ensuring that all medication procedures were consistently followed. When signing money records was offered to service users, they became confused and asked for the existing system to stay in place, as they felt very comfortable with it. Currently, the manager was in discussion with the owners of how to reduce the Care Homes for Older People Page 7 of 24 temperature in the medication room. One of the options she mentioned was to insall an air-conditioning unit. 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 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 8 of 24 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 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided excellent information to service users allowing them to make an informed decision about their choice of home. A comprehensive initial assessment ensured that, once admitted, users needs were met above their expectations. Evidence: The home provided information about the service in their brochure that they kept up to date. Their statement of purpose was reviewed regularly. A service user stated: On my admission, I sat in the office with the manager and all my questions were answered. The information presented to any potential user verbally was excellent, as one of the service users spoken to stated: they invited me to the office and answered all my questions. Three checked files contained documeneted evidence of the initial assessment. The manager reported in their self assessment, AQAA: The fact that we have had no complaints shows that everyone is satisfied and this is evidence that shows we have Care Homes for Older People Page 10 of 24 Evidence: excel in what we say we do, we provide information, assessments and meet individual needs. Service users spoken to insisted that their needs were met. Observation of care processes, such as administration of medication and meal time also confirmed that care exceeded service users expectations. Care Homes for Older People Page 11 of 24 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 home offered very good health care to service users with full respect for their privacy and dignity. Medication process was safe, well organised and ensured users were safe while their abilities to handle medication were promoted. Evidence: Three files were checked and care plans, risk assessments and daily notes showed that records were up to date, that relevant recorded information about individuals were consinstent and used to plan, deliver and monitor care for service users. One of the checked files contained a weight chart that indicated weight gain in the last two months. A care plan noted the change and suggested closer monitoring and involvement of a dietician. The records of professionals visits showed that the dietician visited and provided advice. The care plan addressed this advice. All service users spoken to confirmed that health care was given high priority and that the home reacted on time and appropriately when medical help was needed. Service users files contained records of external healthcare and medical professionals visits. Care plans contained the sections of day care and night care, thus providing more Care Homes for Older People Page 12 of 24 Evidence: accurate instructions to staff on how to help and support the service users. In spite of good and comprehensive records, there were small inconsistencies. One of the files contained recorded allergy written in large print at the begining of the file, while the other allergic user had his allergy recorded only in his care plan. Good connection of information in various files could be further improved by addressing in care plans elements recorded elsewhere, for example in medication folder, or in money records, where the records instructed staff on how to help and support each individual, or to encourage their independence in these areas. In one of the files there was an appropriate risk assessment for self medication in the section covering assessed risks, but the care plan itself did not mention medication, or explained to staff that the user was encouraged to remain independent and continued to use own medication independently. However, a staff member spoken to knew about the medication arrangement for this user and about the risk assessment, thus showing that staff were aware of the risk and the current arrangement. One of the checked files did not have a falls risk assessment filled in. The manager explained that the home was still assessing this newer service user and intended to write up the findings of the assessment once they complete the full assessment. The same file had just one sentence in the section on life history. The manager explained that she was awaiting a users friend to supply more accurate and detailed information before the life history was fully written. The same file contained recorded likes and dislikes in the care plan, obtained from the initial assessment. Medication storage records of administration and amount of tablets were checked for three users of the service and found to be accurate and appropriate. The manager explained that they deliberately did not record medication brought forward from one to another sheet, so that the audit required checking previous sheets. This required more time and effort for the audit, but also ensured a better and more appropiate and more comprehensive auditing process. There were no service users with the prescribed controlled drugs, but the manager explained the procedure for this type of medication and showed existing facilities, should the need for this type arise. The storage room did not have windows or ventilation and the manager explained that she was discussing with the owners how best to address this potential problem. The installation of the air conditioning unit was suggeted as a possible solution. Privacy and dignity were very highly respected and promoted and were the base on which the home built its very good reputation. All nine service users spoken to praised the home for this organisational aspect and for being treated with full respect. A five star hotel would not treat people better, stated a user who demanded an excellent rating for the home. Care Homes for Older People Page 13 of 24 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. Service users were pleased that they could decide on their daily life and routine. Their views were taken into account when activities were planned. The home exceeded these standards. Evidence: The open and approachable staff and management and an atmosphere where service users abilities were highly promoted and respected determined their greatest satisfaction and showed how the standards could be exceeded. A service user was laying the tables in the dining room and anxiously stopped when we entered the room: You are not going to stop me, I love doing this? Three service users stated that they like getting up early and chatting before bgreakfast. The manager explained that the meal times were fully flexible and staff offered these three ladies breakfast several times, before they decided they wanted it. A staff memeber explained that: they sometimes chat for 5 minutes, sometimes for half an hour, and then they have their breakfast. This kind of respect was present during the entire time of the site visit, demonstrating the respect for service users autonomy, independence and flexibility the home showed in arranging daily routine. A service users file showed that he wanted to follow his religious beliefs, and he Care Homes for Older People Page 14 of 24 Evidence: confirmed that he was going to church. The activity records confirmed the statement given in AQAA, a self assessment: We offer a full range of activities, which include monthly quiz night, trips to the theatre and meals out. The home also offered a themed evening meals: chinese, indian and fish and chips, as some service users wanted this traditional meal on the menu. The manager is present in the evening sharing meal with service users and chatting with them. The home had just engaged a new in-house entertainer, a singer who invited service users to join in. Although he was not the choice of a singer that staff preferred, service users insisted and he was brought back. A regular newsletter produced by the home contained all this information and was well accepted by users of the service. Meal times were unhurried and all comments on food determined an excellent rating with all praising the quality and quantity of food. Care Homes for Older People Page 15 of 24 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. Service users were clear of how to complain if they wanted to and were protected by an open atmosphere where all concerns would be dealt with immediately. Evidence: The manager reported that there had been no complaints received in the home and presented this fact in their self assessment, AQAA. There were no complaints received by the regulators, in the our office, either. The procedure was clearly displayed in the home and 3 users confirmed that they knew how to complain. The recruitment process that included various checks on all new staff, clear procedure for reporting potential allegations and measures in place to protect service users from abuse contributed to a very good protection. The home initiated protection procedure related to a family member of a service user and ensured extra support for the user during the external investigation that was currently conducted. Care Homes for Older People Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was pleasant, arranged in a homely way and service users enjoyed a very good state of repair and regular maintenance. Evidence: Regular replacements and maintenance work was carried out as planned. A service user commented: The home is clean and bright. I chose this home because it does not smell of Old people. The tour of the home confirmed the statement from a user of the service and from the homes self assessment. The owners regularly reported on their monthly visit improvements to the environment, as the last report commented on recently planted flowers in their very nice garden. An external laundry room contribted to better infection control measures. The staff and the proprietor were investing both time and money to ensure that the environment and the equipment not only meet the users needs, but initiates service users satisfaction. Care Homes for Older People Page 17 of 24 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. The staff complement was decided to reflect users needs and ensured that sufficient, well-trained and skilled staff were on duty at any time, exceeding the minimum standards. Evidence: Service users particularly liked the principle that staff could start working independently when they knew each user by their name. The team work, so well organised and strong, influenced not only a very pleasant atmosphere in the home, but also satisfaction of service users. A service user explained: It does not metter how many staff are on, they are so well organised and always are here when we need them. Observation of staff work during the site visit confirmed the highly effective organisation and the feeling that staff were always present everywhere. The manager reported that the home was fully staffed and that the training was carried out according to plan. Two NVQ assessors also contributed to exceeding the standard and having more that 60 NVQ trained staff. Attending handover during the site visit showed that all staff knew all service users very well by their preferred name, always given first before giving the full name of the individual discussed. Two staff files checked contained all necessary documents and showed the extra that Care Homes for Older People Page 18 of 24 Evidence: the home was doing: they asked for 3 references for all new staff. Four days induction programme was seen in all checked files. Three staff files were checked and contained all relevant checks. The AQAA also reported: We have never used agency staff, we arrange cover by our regular staff, or engaging the management team as carers and ensure continuity of care. We put an extra name on a rota to cover busy periods. Care Homes for Older People Page 19 of 24 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. An excellent management and commited staff team ensured that service users were not only cared for in the way they wanted, but also ensuring their good protection. Service users were protected by safe working practices and felt safe and secure in the home. Evidence: The manager was registered and had managed the home for a number of years, always ensuring the service users were in the centre of organisaion of daily life. Her open attitude helped creating the atmosphere where both service users and staff felt respected and protected. Although the home did not have a set quality assurance system in place, their alternative was as effective as any of these set structured programmes. The newsletter contained questionnaires and allowed service users and staff to make comments and express their views every two months, rather than once a year, in a standardised way in set quality assurance programmes. Yearly check of all policies was a part of their Care Homes for Older People Page 20 of 24 Evidence: yearly plan, again effectively replacing the task normally included in quality assurance. Records of service users money held securely by staff on their behalf, were accurate, as checked in three cases. Service users did not want to sign the records as they were getting confused by these and the management instructed the procedure to be signed by two senior staff and dealt with by only designated people, thus ensuring full financial protection. Staff supervision and appraisals were also regular and staff spoken to confirmed that they felt very supported, not only through these formal measures, but through the principles of open door of senior staff and the manager. The home was inspected by the Environmental Health and Food and Hygiene inspectors and were awared a 5 star rating consecutively for the second year. There was a new timing procedure to check hot water temperature every 6 months, as temperature controlling valves were installed and proved over a period of time to work effectively. An effective infection control procedure was in place and an external laundry room helped maintain this high standard. service users were protected by the set procedures and safe working practices. Care Homes for Older People Page 21 of 24 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 22 of 24 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 7 Care plans should mention the arrangements for medication and money for individuals, indicating that more specific information could be found in appropriate sections, i.e. medication folder or money records. Care plans should be written in a consistent way to avoid potential omissions of important details, such as addressing allergies in the same places in the individual files, in the front, only in the care plan and risk assessment, or in both spaces. 2 7 Care Homes for Older People Page 23 of 24 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). 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. 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