Care Home: The Homestead Residential Home

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What the care home does well We have recognised the achievements made since the last key inspection, in that requirements and recommendations made at that inspection have been satisfactorily addressed. We have found that The Homestead offers a satisfactory commitment to care with an open and personable approach, which reflects the homeliness of a confident relationship between carers and those people using the service. Comments received from surveys and talking with people during the inspection included: "I would like to say the care and attention mom has received over the past three and half years has been very good. I am always notified if there are any problems, and they do not hesitate to ring for a doctor if they think there is a problem". "I`ve been here now for three years, and found the staff to be caring and friendly, like a family, and the home to be very comfortable. We could do with more interesting things to do, but I`m not complaining". From our examination of care records we established that there are effective pre admission assessments, and care planning of individual needs, which are meaningful in formulating a satisfactory standard of personal care. When we discussed the quality of care with those people using the service and visitors, it was clear that they appreciated this personable attitude and approach to care. The housekeeping, administrative and support services have all contribute to the team approach, and are recognised by the management for their efforts. Comments we received from relatives during the inspection include: "The home have taken away most of the stress I experienced before my mum came here, as I know they are taking good care of her, ask me things about mum, and tell me anything I need to know, when I need to know". "The home is efficiently run, but with a lot of patience and kindness. My mother who is a 101 years old, who lives at The Homestead, she is extremely happy there, and is very well looked after in every way. We have no complaints whatsoever". We considered that the overall management style demonstrated a solid approach in maintaining an environment conducive to the care of the elderly. What has improved since the last inspection? Our inspection has clearly identified a much clearer person centred approach to care, especially for people with dementia. The arrangements for activities and socialisation have shown some improvement, although much still needs to be accomplished to offer people an inclusive quality of life, and a sound foundation to provide a good standard of care. Various comments we received through surveying from people in the home: "Caring staff, comfortable rooms, good food, staff always available though often very busy. Could do to engage with residents more, but may need extra staff to allow time for this". "A comfortable, friendly place to live, a very pleasant environment, it`s a lovely place in every way ". "The Homestead has always achieved a high standard of hygiene and cleanliness, I am very happy, as is my mum who lives there". We have acknowledged that there have been significant improvements in the furnishings and decor throughout the home, presenting a comfortable, safe environment, and to assist people, especially those with a higher dependency of care or dementia needs. Our discussions with staff confirmed an improvement in the standards of staff morale, motivation and training, through sound management. Information gathered from the AQAA and discussed during our inspection found this to be true. What the care home could do better: We considered that much could be achieved by the recognition of a dedicated activity coordinator, to facilitate and promote stimulation and diversion for people living in the Home. More variety in indoor activities would be beneficial, especially for people with dementia and other cognitive impairments. Consideration be given to present the Service User Guide in an audio version to facilitate an informed decision for those people challenged with poor eyesight. To review the use of assisted bathrooms by completing a planned-for redecoration and refit programme. We also advise re-designing access to a bedroom with an hazardous threshold, and glass frontage door. We feel that to promote transparency and achieve effective control that the Registered Provider conduct an audit of financial account related to resident`s monies as an established routine. The achievements have been recognised, attention to areas of further recommended detail will significantly enhance the provision of an honest, solid and homely service. Key inspection report Care homes for older people Name: Address: The Homestead Residential Home Wolverhampton Road Prestwood Near Stourbridge West Midlands DY7 5AN     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: Keith Jones     Date: 0 8 0 4 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 34 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 34 Information about the care home Name of care home: Address: The Homestead Residential Home Wolverhampton Road Prestwood Near Stourbridge West Midlands DY7 5AN 01384872555 01384873642 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Elysian Care Limited Name of registered manager (if applicable) Joyce Lappage Type of registration: Number of places registered: care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 37 The registered person may provide the following category 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 (DE) 37, Old age, not falling within any other category (OP) 37, Physical disability (PD) 37 Date of last inspection Brief description of the care home The Homestead is a thirty seven bedded care home for independent elderly people of pension able age requiring help with personal care and daily living tasks. The Homestead promotes independent living and offers a person centred care approach to Care Homes for Older People Page 4 of 34 2 9 0 5 2 0 0 9 37 0 37 Over 65 0 37 0 Brief description of the care home meet individual assessed needs. The Homestead is not registered for nursing care, but will endeavour to care for people as long as possible within its category of registration. The frontage of the home provides the main outside sitting area, offering a very pleasant vista throughout the year, and a popular sitting area during the summer months. There are gardens with lawns, fruit trees, and flowered borders to the rear of the building. Set in a semi rural location yet within easy reach of neighbouring Kinver, Stourbridge, and Kingswinford. Accommodation at the home is of a good standard, and offers both shared and single bedrooms with the majority having en/suite facility. There are assisted bathrooms and a hairdressing salon. A passenger shaft lift is located off the main hall, there are three lounges, of which two have a television and the dining room is located at the rear of the lounge. The full range of fees were not detailed in the services Statement of Purpose or Service User Guide documents as routine. The reader may wish to contact the service to obtain more detailed and up to date information about fees. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We conducted this unannounced inspection with the Care Manager, Operations Manager for Elysian Care, and senior care staff on duty, and an Expert by experience, whose input contributed to this report. An Expert by experience is a person who, because of their shared experience of using services and ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in, or use the service. The Registered Provider joined the inspection later in the morning, and remained for most of the day. Our inspection of the Home allowed us free access to all areas and open discussion with people who use the service, relatives and staff. There were 33 people in residence on the day of our inspection. We looked at how care is being arranged and supported for a range of people with personal care needs. To do this we looked at (case tracked) three peoples files from admission referral to the present time, and three staff files were examined. We also looked at other information such as complaints, incidents, Care Homes for Older People Page 6 of 34 events and other professional reports. We took the opportunity to speak with a number of people who are using this service, relatives and members of staff, who took an active role in our inspection process; their input contributed to the subsequent report. We acknowledged receipt of the Annual Quality Assurance Assessment (AQAA), and eight survey forms returned that we sent out to people who use the service some weeks before the inspection, and six staff responses were received. We inspected a sample review of administrative procedures, practices and records, confirming satisfactory practice and management. There followed an inspection report feedback, involving the Registered Provider, Care Manager and Operations Manager, in which we offered an evaluation of the inspection, indicating those requirements and recommendations resulting from the inspection. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? Our inspection has clearly identified a much clearer person centred approach to care, especially for people with dementia. The arrangements for activities and socialisation have shown some improvement, although much still needs to be accomplished to offer people an inclusive quality of life, and a sound foundation to provide a good standard of care. Various comments we received through surveying from people in the home: Caring staff, comfortable rooms, good food, staff always available though often very busy. Could do to engage with residents more, but may need extra staff to allow time for this. A comfortable, friendly place to live, a very pleasant environment, its a lovely place in Care Homes for Older People Page 8 of 34 every way . The Homestead has always achieved a high standard of hygiene and cleanliness, I am very happy, as is my mum who lives there. We have acknowledged that there have been significant improvements in the furnishings and decor throughout the home, presenting a comfortable, safe environment, and to assist people, especially those with a higher dependency of care or dementia needs. Our discussions with staff confirmed an improvement in the standards of staff morale, motivation and training, through sound management. Information gathered from the AQAA and discussed during our inspection found this to be true. 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 34 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 34 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. The needs of people who may use the service are appropriately assessed before they are offered a place. They and their relatives can be confident that the service will be able to meet their needs. Evidence: We examined the services recently revised Statement of Purpose and found that it provided a suitable description of The Homesteads aims and objectives, and was readily available for general distribution. We acknowledged that the informative Service User Guide is presented to all enquirers, and is produced in large print as and when necessary. We also advised that the Guide be updated to reflect changes that have occurred recently, and that an audio and pictorial version would help people to make an informed choice. Information concerning fees payable were not included. The Statement of Purpose indicates the terms and conditions, which are discussed with people who may use the service and relatives prior to admission. The Home has a clear statement of contractual agreement, with reference to the agreed bedroom of Care Homes for Older People Page 11 of 34 Evidence: residence. It is stated in the AQAA, and we recognised that the Statement of Purpose represents the basis on which the home operates upon, offering those people who may use the service, and their relatives, the opportunity to make an informed choice about where to live. Our examination of four peoples care records and plans, identified that each person had an individualised pre admission assessment, with sufficient information recorded to form an appraisal of that persons needs and capabilities, assessing the social background, and were consistent with dating and ownership of the assessor. We identified that the Care Manager or her deputy, at the point of referral, conducts the pre-admission assessment. We found each record showed the attention to individuality, with the assessment formulating a care support plan, based on individual needs, with focused aims and interventions. This assessment is produced with the involvement of those people admitted and family, allowing them to have an influence in the direction of care. From our examination of care files we found that the assessor determines the suitability of the application in view of the facilities available, and of the capacity of the home to manage the person, and any special needs. The plan of care, which includes a profile with physical, mental and social assessments, stimulating a daily living plan. A plan of care based on personal needs and daily living processes is then produced from the assessment information obtained. From our discussions it was evident that people are able to visit and assess the quality, facilities and suitability of the Home at any reasonable time, to meet with staff and management. Comments received showed to us a confidence that people had in the service: The home have taken away most of the stress I experienced before my mum came here, as I know they are taking good care of her, ask me things about mum, and tell me anything I need to know, when I need to know. Mum stayed at The Homestead for two weeks prior to becoming a resident. To begin with I was very nervous but I was made welcome and felt involved at all times. No intermediate care took place in the home. Care Homes for Older People Page 12 of 34 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 needs are addressed through the care planning process, meeting clear principles of respect, dignity and privacy. Medicine administration systems are safe and secure. Evidence: Our examination of care records and case tracking showed a good quality process of assessment, with individual care plans developed for person admitted to the home. The pre-admission assessment established the foundation for a well considered, and detailed care planning process, including risk assessments for mobility and falls, tissue viability and nutrition. Each persons health, personal and social care needs were found to be appropriately assessed in an individual plan of care that is reviewed monthly, to reflect their changing needs and adapting care profiles, supported with an informative daily progress report. The AQAA stated, and we confirmed that those people who use the service, families and friends are invited to participate in the care planning process, and established monitoring systems following a process of goals, care, and evaluation of quality care plans. Care Homes for Older People Page 13 of 34 Evidence: We examined four peoples care files in detail, each demonstrated essential information on the individual, their life style and needs, events and contacts, procedures and actions monitored on a daily basis and reviewed monthly. Effective risk assessments had been completed in areas such as manual handling, falls, nutrition, personal hygiene, and continence. The process has also established a social awareness for each person, as an addition to care records, which has proved to be useful in enhancing understanding of personal needs. Case tracking confirmed to us that specialist support and advice are sought as needed, with each person using the service having access to a local Doctor, Dentist, Optician, Chiropodist, and District Nurse as required. We consider that the strength of planned care lies within the frequency of the review process in monitoring and adapting care profiles and risk assessments. Included in the care records were applications of established monitoring systems following a process of recognition and evaluation. Our observations showed that generally people using the service appeared to be content, comfortable and happy with their lifestyle, complimentary regarding the quality of their lives and the care they were receiving at The Homestead. Several relatives were visiting and we asked for their comments on the quality of the service and care given. There was a clear appreciation of the openness and opportunity to contribute. All comments were complimentary of standards, facilities and staff: I would like to say the care and attention mom has received over the past three and half years has been very good. I am always notified if there are any problems, and they do not hesitate to ring for a doctor if they think there is a problem. The staff are cheerful and welcoming to visitors and look after the residents well. The home is efficiently run, but with a lot of patience and kindness. My mother who is a 101 years old, who lives at The Homestead, she is extremely happy there, and is very well looked after in every way. We have no complaints whatsoever. We saw that carers responded and exchanged with people who use the service with familial confidence and friendly compassion. In the progress of meeting people who use the service it was acknowledged that their general appearance indicated that their health and personal care was attentive and effective. Examination of care records and observation of practice, confirmed that the provision of care for people were of a good standard. Care Homes for Older People Page 14 of 34 Evidence: The expert by experience offered comments received from her discussions with people: I get the help I need without having to ask. When I feel unwell they get the doctor or nurse in to look at me without any fuss. Nothings too much trouble. Very satisfied with the care my parents receive, I visit my husband every day and so I know the care is always good and consistent. Generally the arrangements for care planning are improved, and are being continually updated. Pre admission assessments were consistent in approach, and gathered the necessary information. Good standard of planning and review. Cross referencing accidents and events with care plans showed a connection of appraisal. We found the administration of medicines generally adhered to procedures to maximise protection to people who use the service. The storage was secure, with good environmental controls, including a medicines fridge. Our examination of the record of administration of medicines showed consistency, with no omissions observed. Staff signatures were up to date. A controlled drug register was examined and we found to be up to date when checking drug stocks. Controlled drug security is satisfactory following a review of facilities. Staff training continues to be pursued actively by the care manager. We found an effective and smooth process of ordering, receiving, storing, administering and disposing of medicines. Records were seen to be complete and easy to follow through, with no observed breaches in the system. We acknowledge that in the services Statement of Purpose and the AQAA, that independence, peoples privacy and dignity are encouraged, with the full involvement of family. This was confirmed in our discussions with people who use the service. visitors and staff, and that relatives have freedom of visiting, which emphasised the importance of maintaining social contact. In our discussions with people who use the service and staff it was recognised that diverse needs were accommodated within the planning of care, with people we talked to being complimentary of the degree of respect given, by each and every member of staff. We recognised the confidence and closeness within the Home and the mutual respect that prevailed. The Expert by experience commented: During my time at the home I observed how staff interacted with residents both formally when carrying out caring interventions and informally when going about other duties in the home. My perception was that the staff group as a whole know individual residents very well, are aware of their differing needs, likes and personalities and Care Homes for Older People Page 15 of 34 Evidence: respond accordingly. The atmosphere appeared easy going and friendly banter occurred between residents and staff but residents were afforded respect and dignity, and staff observed to be professional at all times. Our discussion with visitors on the day were helpful exchanges, all being very complimentary of care: I would like to say the care and attention mom has received over the past three and half years has been very good. I am always notified if there are any problems, and they do not hesitate to ring for a doctor if they think there is a problem. The staff are cheerful and welcoming to visitors and look after the residents well. The home is efficiently run, but with a lot of patience and kindness. My mother who is a 101 years old lives at The Homestead, she is extremely happy there, and is very well looked after i every way. We have no complaints whatsoever. Care Homes for Older People Page 16 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights to live a meaningful life are central to the homes aims and objectives, and are offered opportunities to exercise choice and control over their lives. People are offered a healthy, well balanced diet. Evidence: Throughout the period of inspection we found the daily routine to be flexible, offering choices and diversity for personal and social activities, religious needs and meals. Our discussions with people who use the service, and staff, clearly identified a relaxed and informal atmosphere in which the peoples needs were respected, with the security that there are familiar events to the day they could relate to. People also exercise choice in the time they get up and go to bed. One daughter expressed her initial surprise and delight at this: I came one morning and mum was still in bed, staff had let her sleep in but checked her every half hour to see if she was awake, thats normal life and I like it. We reinforced the principle that activities are a key element in the socialisation and motivational approach to care, and involvement. The home has elected to present activities through the carers allocated each shift, which showed deficiencies in the Care Homes for Older People Page 17 of 34 Evidence: programme of events and commitment. During the course of the inspection we saw staff interact with people in a positive and polite manner, although we observed there were instances of lower levels of contact with people with dementia. Observations and comments received from the expert by experience were: In terms of socialisation the home recognises the importance of working closely with residents and their families and of involving them both before and after admission to ensure individual care needs are met. This was substantiated by a visitor who spoke of her close involvement before and after her parents moved to the home. She also told me that families are encouraged to participate in activities arranged for residents and that at Easter there had been a lot going on, Easter Bonnet competitions, an accordionist had come in, there had been a sing song and a fish and chip supper which had been really good. Her mother is a keen gardener, I have been gardening this morning and I am going to grow potatoes and tomatoes this year. The home has made it possible for her to pursue this interest by developing part of the outside garden space, and hope others will also get involved. Recent events include a group of performing dogs, and various musicians, and notices were put up advertising a Tea Dance, a local church choir to do a songs of praise type concert, and residents and staff have been asked to choose their favourite hymns. The home is also visited by patting Dogs on a regular basis, and individuals spiritual needs are met by visiting clergy, when several residents are collected on Sundays and taken to local churches. Although many residents have families who take them out, staff members felt the home should be more proactive in organising activities both in the home and in the wider community especially for residents with dementia. They were aware of the value of increased stimulation, but unable to do more because of lack of time. They felt that more time should be given to develop an activities programme and that residents would benefit from one to one and group activities. Comments received from people regarding their health and social status: Caring staff, comfortable rooms, good food, staff always available though often very busy. Could do to engage with residents more, but may need extra staff to allow time for this. Need more activities, for me the only pleasure is my daughter taking me out at times, and having visitors, watching TV, and reading in my room. A staff comment was received: Given the land surrounding our beautiful home, we could provide beautiful surroundings for our service users, such as a vegetable garden, beautiful colourful flower beds, and if safe to do so, other activities; a small Care Homes for Older People Page 18 of 34 Evidence: area to play outdoor games for those able to do so, such as bowls, and a patio area for all, with garden features. Nonetheless we recognise the home is committed to enhance the socialisation process in planning to appoint an activity coordinator, and extended activities to add to those already in place The Statement of Purpose identifies that personal choice and relative self determination are respected in policy and action. Those individuals rooms inspected showed a positive influence of personalisation in the inclusion of belongings, some furniture and general decor. We recognise the extensive work done in creating a familiar environment, using discrete colour schemes and memorabilia to assist people with dementia to exercise a degree of freedom, and recognition. Relatives and friends are encouraged to maintain social links as part of the planning of care. We found that the standards of catering continue to offer a satisfactory service, to which those people we spoke with were complimentary. A menu, on a four weekly cycle offered a varied and suitable choice. We observed a very pleasant lunch served during inspection, a choice of two main meals, roast beef or a meat free pasta bake, and three desserts. The quality and quantity of the food offered on the day was observed to be of a good standard, confirmed by those people we talked with, served in a comfortable and clean dining room. Most residents were able to eat independently but where assistance was needed it was offered in a polite and respectful manner, and at a level appropriate to individual need to encourage independence and maintain dignity. Varied and well presented, good quality, and Very good standard of cooking and choice available. Its always set out so nice. The Expert by experience observed: I was told by one lady that they are asked what they want for lunch every morning. I was told that the food is good at all meals and theres always plenty of it. I joined residents for lunch in the dining room which a visitor said: always looks inviting, they have proper linen cloths and napkins, set out with small tables of four or six. I observed that for many it was a social occasion, with chatting and interaction taking place between both fellow diners and staff. We saw that staff offered discreet assistance to those who required it. The choice of Care Homes for Older People Page 19 of 34 Evidence: dining room, lounge or bedroom was at the discretion of residents. From our discussions we confirmed that the cook knew each person using the service, and some of the relatives, understood and recognised diversity, and indicated an awareness in meeting individual needs. Individual preferences were recorded in assessment and conveyed to the catering staff, who met with, and discussed their requirements. The cook told us that they try to buy local produce when they can, and she knows all the residents likes and dislikes personally. Care Homes for Older People Page 20 of 34 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. The service has a meaningful complaints policy. People are given opportunities to freely express any concerns, and these are quickly responded to. People are protected from abuse, and their human rights are promoted. Evidence: The services AQAA identified that the service had a clear complaints procedure illustrating time scales and how the complaint would be dealt with. Service users can be provided with an advocate if necessary. There were a few minor concerns, dealt with through a record of concerns, complaints and safeguarding, to record peoples concerns in a meaningful and effective manner. Since the last inspection two issues had been referred to the safeguarding team. Each had been investigated, discussed with the provider of the service and addressed satisfactorily. Surveys we received indicated that people had received information on the procedure to complain, including reference to us. This process was evidenced through the Service User Guide, on examination and case tracking and discussion. Comments we received from people who use the service through the surveys returned: In the past five years I have never had to. I would tell the staff and the manager if I was unhappy, they have always been understanding and helpful. I know there is a procedure. Care Homes for Older People Page 21 of 34 Evidence: We examined three staff records to confirm that staff were suitably checked through Criminal Records Bureau (CRB), and Protection of Vulnerable Adult (POVA) disclosure. We found staff received training on abuse at induction, this includes the right to whistle blowing, consistent with the Public Disclosure Act, 1998. Three staff on duty told us they had received the appropriate training to safeguard and protect people who use the service. A comment received: Communications levels are good, with staff, managers, service users, and their families, enabling us to deliver top quality service, maintaining the health, safety and wellbeing of each individual. Our discussion with the care manager confirmed that there is satisfactory evidence of a protocol and response, to anyone reporting any form of abuse, to ensure effective handling of such an incident. The policy and procedure for handling issues of abuse was examined, and found to be appropriate. Care Homes for Older People Page 22 of 34 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 Homestead provides a safe, well maintained, clean and comfortable environment for the people who use the service. Evidence: The Homestead Residential Home is located on the A449, near Stourbridge. The two storey property is situated within its own grounds. The home offered a range of single and shared occupancy bedrooms, located on both the ground and first floor, and that people are encouraged to personalise their bedrooms. External access is set off a main road, in beautiful pastoral countryside, to which people take advantage of an attractive garden, lawns and patio at the front of the building, with those pathways safe and maintained. Our inspection of the home verified that the premises were generally fit for purpose, clean warm and tidy, having been extensively redecorated and maintained, offering a comfortable, homely yet secure environment. Much effort has been taken to make good patio and walk ways, ensuring the foundation for improved facilities for people to take advantage of. Plans are underway to erect a greenhouse at the front patio area to present an effort to provide gardening opportunities, including a herb garden and more use of the grassed frontage to the Home. We were informed that on admission the Care Manager assesses each individuals Care Homes for Older People Page 23 of 34 Evidence: needs for equipment and necessary adaptations, we found this to be correct, and saw those facilities available throughout the Home, with suitable fittings of hand and grab rails, in most of the corridors. We found some areas difficult to access, including a room with a raised threshold and a glassed front door. It was agreed to re-site the entrance and secure privacy. Efforts had been made to provide a homely atmosphere and the decor in most areas of home was found to be pleasant and personalised to meet the needs of people with dementia, through discrete colour schemes and the use of recognisable ornamentation. The Home provided three lounge areas that were pleasantly decorated, providing comfortable areas where people were able to interact, or to entertain their guests. A pleasant, homely dining area was clean, and conducive to enjoy a good meal. The home presented to us a generally clean and pleasant atmosphere, much to the credit of staff. To complement the presentation there were numerous floral and decorative displays. Toilets and bathrooms were located in close proximity to bedrooms and communal areas. One bathroom had been extensively upgraded although the hoist was not serviced and thus the room rarely used, Another bathroom requires an upgrade through poor maintenance and presentation. A sluice was inspected and found to offer a satisfactory facility. Bedrooms have been extensively redecorated since the last inspection, are well maintained to meet peoples personal preferences, displaying personal furniture, and personal belongings. It is the policy that on bedrooms becoming vacant that each room is reappraised for redecoration, as confirmed during the inspection. We confirmed the good quality of outcome from a major refurbishment of bedrooms, to which people spoken to expressed a sense of belonging and satisfaction in the quality and presentation of their living areas. The care manager expressed a willingness to meet any reasonable demand for special needs. A locked facility and lockable bedroom doors are made available on request, following suitable risk assessment. Comments we received from a survey we sent out before the inspection, and from people we talked with on the day: A comfortable, friendly place to live, a very pleasant environment, its a lovely place in every way . The Homestead has always achieved a high standard of hygiene and cleanliness, I am very happy, as is my mum who lives there. Comments and observations we received from the Expert by experience: Care Homes for Older People Page 24 of 34 Evidence: The atmosphere in the home was relaxed, calm and friendly. Communal lounges and dining area were clean and pleasantly decorated to an acceptable standard. A visitor commented: All in all Im impressed, its good here. Recognition of the individuality of residents was also seen in their rooms, all those seen were personalised to a high degree with their own furniture as well as smaller personal items such as photographs. People told me: You wont find anything wrong here love. Got a lovely little room, my own furniture, couldnt ask for more if I had a catalogue to choose from. Mum was able to bring quite a lot of her furniture, was good as it had sentimental value, helped her to see it as her new home. We found the kitchen presentation showed satisfactory standards of cleanliness, and evidence of sound food hygiene practices, and a well equipped and organised area, although poorly ventilated. All fridges and freezers were well maintained and checked daily by the kitchen staff. We spoke with the cook who confirmed to us that she actively engages with people who use the service to determine their needs. She was aware of the issues of culture, ethnicity and age diversity, having had experience in dealing with a diverse population. We found the laundry arrangements much improved, was well organised and equipped to a satisfactory standard. Chemical and disinfection safety regulations were evidenced, enhanced with posters clearly displaying, and relevant to solutions in use. Care Homes for Older People Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels ensure that suitably trained staff are provided to meet the needs of people who use the service. Recruitment processes are consistent and robust, protecting the people who use the service from harm and abuse. Evidence: There were 33 people using the service on the day of inspection, 14 people with dementia needs. Three weeks of duty rotas were examined, providing evidence that the home is suitably staffed in numbers, skills and qualifications to ensure the needs of people are met. We recognise the improvements made in staffing levels from the last inspection. On the day of inspection the staffing levels were: Morning shift 1 Senior Carer and 5 carers (including an 11:00 to 16:00 shift). Afternoon shift 1 Senior Carer and 3 carers Night duty 1 Senior Carer and 2 carers We confirmed the Care Manager works supernumerary, and is supported by a team of experienced carers. Agency coverage has been used to support shortages of care staff, in tandem with overtime and flexible rostering. There are adequate support staff for housekeeping, catering, administrative and maintenance. Care Homes for Older People Page 26 of 34 Evidence: The care manager has the Registered Managers Award, and we were informed through the AQAA that 16 staff have National Vocational Qualification (NVQ) level II and level III. This was confirmed on examination of training records and speaking with staff. It is recognised that staff received a meaningful training programme to compliment induction, and to enhance supervision. There are ten members of staff qualified in first aid, each with a valid certificate. The Expert by experience related: The home operates a key worker system and one lady said all the staff were very good and thorough, and she liked it that there was: a special one who looks after me mainly when she is here. One resident couple commented how happy, safe and content they felt being together in the home: Theres someone to look after the wife, take her to the toilet, wash and dress her like I used to do at home, before I needed help myself. Family visitors also expressed satisfaction with the care and services provided. All visitors I saw praised staff and management for the way in which they communicate and work in partnership with residents, their families and friends to provide the best care. Comments included: I have been here literally at all times of the day. Staff are always very welcoming, never complain or moan whatever time you visit. We examined three staff files, each providing satisfactory evidence that the process of appointing new staff were well organised, consistent and contributed in safeguarded the interests of residents. The thoroughness of staff selection has a significant effect upon the provision of care to ensure protection of people. Three staff on duty were interviewed, each spoke well of the training and supervision offered to them, and of the good working conditions that prevail. Our discussions with staff also confirmed their commitment to providing a quality service, and their awareness of the principles of good practice and code of conduct. There were no problematic issues raised by the staff. We were aware from discussions and records seen that no person was employed without the application for a Criminal Records Bureau (CRB) Protection of Vulnerable Adults (POVA) list check. All new staff goes through a detailed induction process that will ensure that they are going to be the right person for the home. Discussion with staff demonstrated an on going process of supervised practice, and staff meetings are held on a six monthly basis. Comments received from people using the service included: The home could do with more staff. The ladies and gents that work here are always under pressure. Care Homes for Older People Page 27 of 34 Evidence: Ive been here now for three years, and found the staff to be caring and friendly, like a family, and the home to be very comfortable. We could do with more interesting things to do, but Im not complaining. Members of staff told us; I feel the Home does well meeting our residents needs. We have a really good work force, who I feel, do care about the residents. When fully staffed activities are done on a regular basis. Need more staff meetings, and residents need to be taken out more. The care that is provided by the care staff is second to none, and I believe the residents are looked after very well. The home also does feel homely and not institutionalised. Care Homes for Older People Page 28 of 34 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 care team promote the health, safety and welfare of people using the service, and working practices are safe. People who use the service can be assured that the home is run in their interests, based on openness and respect. Evidence: The experienced care manager has over the past year demonstrated a willingness and determination to address the issues raised at the last inspection, reinforcing the establishment of a solid management foundation, implemented to achieve a good standard of set aims, objectives and care. We acknowledge that she has been actively engaged in quality reviews and audits with the Registered Provider, following our last inspection, meeting compliance to requirements and addressing recommendations we made. She has 18 years experience in social care and had obtained the Registered Managers Award, National Vocational Qualification level 2 and 4, and the Assessors Award. Care Homes for Older People Page 29 of 34 Evidence: We observed an openness, professional and pleasing confidence in the interactions of staff, relatives and people who use the service, based on mutual trust and respect. Comments from those people we met and surveyed included: We have found that if there is anything you need to speak about you can see the manager or another member of staff at any time. Makes sure we are safe, well looked after with contact with our family. Extremely happy with the staff and the home, very relaxed, friendly, homely atmosphere. The Expert by experience assessor stated: In terms of care and services my observations and discussions indicate that the daily care and services the home provides appear to meet the needs of the residents who live there well. Residents and family members appear very pleased and satisfied with the service and residents are treated with dignity and afforded choice about their daily routines. Through the inspection process we found appropriate risk assessments in place for people using the service, through care planning and monitoring, staff selection and of the general environment, these are up to date and accurate. Health and safety notices can be seen throughout the Home, and chemical safety notices were seen in areas of use and storage. An examination of administrative, monitoring, planning and care records showed to us a generally diligent attitude to effective record keeping, we found them to be well maintained in ensuring that the peoples rights and best interests are safeguarded. Records we inspected included recent fire prevention, hoists and water inspections; each were examined and found to be up to date. The Manager offered evidence of procedures and safe working practices including: movement and handling, confidentiality, and abuse awareness. The procedure manual has been reviewed to help to staff to keep updated to meet new situations, especially in light of changes in Mental Capacity, Deprivation of Liberties, and Safeguarding regulations. We also found that supervision has been re established to meet good practice standards. We saw records of resident and relative meetings, which are a regular feature of quality assurance. Comments from those attending included: I like the activities, would like more outings. Could be better with communications, messages not always passed to the Care Homes for Older People Page 30 of 34 Evidence: appropriate person. They could provide escort service for medical appointments, and need more activities suitable for people with dementia. The care mom receives is very good, she is always clean and well presented. The home could do with more staff. The ladies and gents that work here are always under pressure. The accident book was seen and found to be in order, with a regular analysis of trends and frequency. Our examination of those records showed an effective follow through of action taken, including a review of care plans if necessary. We were informed through the AQAA, and by the manager that financial arrangements are supervised and administered by the Care Manager in respect of pocket money, hairdressing, private chiropody and petty cash management. We saw the records for the monies held on behalf of the people who use the service. Each entry was balanced on a monthly basis, although we advised that a regular audit by the Registered Provider be instigated. The administration and management of the home is considered by us to be efficient, uncomplicated, and sensitive to the needs of people. Care Homes for Older People Page 31 of 34 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 32 of 34 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 12 16 That the Provider establish 01/06/2010 an activity co-odinator and a formal programme of activities to promote socialisation and inclusion, especially for people with dementia care needs. To provide opportunities for stimulation through leisure and recreational activities in and outside the Home to suit their needs. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 21 24 Upgrade bathroom and ensure equipment is serviced, to offer a satisfactory level of assisted bathing in the Home Re-site the door of a bedroom fitted with a glassed front door and raised threshold, to enhance safety and privide privacy. That the Registered Provider conduct an audit of financial account related to residents monies. Page 33 of 34 3 35 Care Homes for Older People 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. © 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. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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