Care Home: The Laurels and The Limes Care Home

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What the care home does well The home was clean and fresh smelling. We saw good interaction between staff and people living at the home. Staff were knowledgeable about individual people`s needs and personalities. Staff were encouraged to train and extend their knowledge and skills. Three people told us that they can "Make my own decisions", Tell staff what I want", and "Staff help me whenever I ask". One relative told us that, "The staff are lovely, they look after my relative and I can talk to them about any issues I may have and they will sort things out". What has improved since the last inspection? People said they were happy with areas of the home that had been redecorated and refurbished. People whose rooms had been redecorated and refurbished were happy with the outcome; they were pleased to have been offered a choice of colour scheme. What the care home could do better: Continue to update and refurbish people`s bedrooms and communal areas. Ensure that the storage of wheelchairs does not present a risk of accident. Key inspection report Care homes for older people Name: Address: The Laurels and The Limes Care Home 115 Manchester Road S Yorkshire S10 5DN     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: Ian Hall     Date: 2 0 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 26 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 26 Information about the care home Name of care home: Address: The Laurels and The Limes Care Home 115 Manchester Road S Yorkshire S10 5DN 01142660202 01142661178 kersal.mount@hillcare.net www.hillcare.net Hill Care Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 88 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only Care Home only - Code OP Care Home with Nursing Code N. To service users of the following gender - either whose primary care needs on admission to the home are within the following categories - Old age not falling within any other category Code OP Dementia Code DE The maximum number of users who can be accommodated is 88 Date of last inspection Brief description of the care home Hillcare Limited is registered to provide nursing care for up to 88 older people. The majority of bedrooms are single. A proportion of both single and double rooms are provided with en-suite facilities. The home provides a range of communal areas and bathing facilities. The home is within two separate buildings, close to one another. One is a stone building, which has been converted, the other a stone, purpose built Care Homes for Older People Page 4 of 26 Over 65 0 88 20 0 1 9 0 8 2 0 0 9 Brief description of the care home premise. The homes gardens are landscaped and well maintained. A car park is provided. The home is situated on the south side of Sheffield. Local amenities are a short walk away. Public transport passes the home. The manager told us that the current fee range was £344.00-£750.00. There are additional charges for chiropody, hairdressing, holidays, magazines, newspapers, toiletries and staff escorts for outings. Further information relating to these charges may be obtained from the homes manager. Information about the home is provided to people and their representatives in the form of a service user guide. Leaflets and other general written information are posted around the home and available at the homes reception. The inspection reports are displayed in the entrance to the home. Care Homes for Older People Page 5 of 26 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: The quality rating for this service is 2 stars. This means that the people who use this service experience good quality outcomes. We reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The unannounced site visit undertaken as part of the inspection started at 09:20 and concluded at 15:20 on the 20th April 2010. The inspection was conducted by the lead inspector Mr I Hall. The site visit included a tour of the building, reading records, discussions with staff and Care Homes for Older People Page 6 of 26 people who use the service and observation of the meals provided. We also met with the manager and other members of staff. In addition the inspection took account of information received about the service since the last key inspection 19th August 2009. This included records of telephone conversations with staff, events notified to CQC, and records of management visits to the home. Prior to the site visit the home carried out a self assessment of the service. This is called the annual quality assurance assessment (AQAA). People spoked with were happy to assist with the inspection. At the end of the site visit verbal feedback was given to the homes management. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? 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 8 of 26 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 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People did not move into the home without having their care needs assessed so they could be confident the home could support them. Evidence: We sampled three peoples care files. Each contained a detailed needs assessment; this included such things as daily living, personal care, health care, social interests and areas of risk when appropriate. Whenever the need for specialist caring equipment had been identified this had been obtained prior to the person moving into the home. The care plan had been compiled from the assessment. People said they had been able to discuss their wishes prior to making the decision to live at the home. Whenever possible people had been encouraged to visit and spend time at the home so they could meet members of staff and other people living at the home. This was confirmed by written entries in the case files. Care Homes for Older People Page 10 of 26 Evidence: Copies of contracts, social work referrals and assessments were available and kept in the case records. Care Homes for Older People Page 11 of 26 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 had been assessed; care plans informed staff how to meet their needs. Evidence: We sampled three peoples case files. Peoples care needs had been assessed. A range of recognised assessment documents had been used to measure peoples needs. These included mobility, metal ability, state of nutrition and areas of risk such as falls. They provided a baseline for staff to measure peoples progress or increasing level of need so staff could plan the help and support people required. There were care plans to tell staff how to meet these needs. These had been reviewed regularly. Many of the people we spoke to knew about their care plan. Relatives said they were kept informed and involved whenever possible. Care plans detailed peoples religious and cultural needs and the gender of staff they wanted to support them with their personal care. Pen portraits of the person, their lives and interests provided staff with background information to personalize the care and services provided. Daily entries were made of care provided. This enabled staff to review peoples health and wellbeing and change plans of care as necessary. Care Homes for Older People Page 12 of 26 Evidence: There were records of visits by the GP, community nurse, dentist, optician, and chiropodist. All people were registered with a family doctor, there were good relationships with the doctors and district nurses. There were sufficient wheelchairs, aids and equipment provided to meet peoples moving and handling needs. These enable people to maintain their independence and move safely. People living at the home said that The girls are wonderful, very professional and The staff have endless patience, they treat me very well and Im very happy here, it would be impossible to find a better place and nicer people. People said that staff promoted their privacy and dignity. We saw staff knocking upon bedroom doors and waiting to be invited to enter. We observed interactions between staff and people living at the home. These were warm relationships with each person showing respect for the other. We saw staff dispensing medications and helping people to take them. The medication records we sampled had been completed correctly. Medicines were seen to be stored securely. No one was responsible for taking their own medicines at the time of our visit although facilities were available should anyone wish to do so. We saw that there was a wide range of medical dressings and products available for peoples wounds and medical needs to be safely met. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities were provided, contact with family and friends was encouraged. This meant that peoples daily life and social activity needs were largely met. Evidence: We sampled three case files and care plans. Entries showed that people had chosen to be involved in a range of social activities. We saw people reading, playing games, watching TV, and conversing with their friends. A member of staff was employed to organise activities to stimulate people and encourage social interaction. Entertainers visit the home for peoples enjoyment. Outings to places on interest, shopping and meals out had been recently enjoyed by people. No one currently leaves the home unless accompanied by a member of staff or a relative. People using the service told us they were ale to see their family and friends whenever they wanted to. Staff told us they felt it was important that contact with family and friends was maintained. People told us they were able to make choices about how they spent their day and who they spent their time with. They said they were able to rise and retire to bed as they wished and always had a choice of meals. Relatives commented that the cook Care Homes for Older People Page 14 of 26 Evidence: had made a whole number of changes to try and meet their loved ones particular dietary needs and preferences. The meals provided were appealing and smelled appetising. People said they enjoyed their meals. They said they could choose other meals if they didnt like the one provided. People were seen and heard to make choices at dinnertime. Staff were seen to help people with their meals and drinks with empathy. The mealtime was unhurried with extra portions available for people. Peoples likes and dislikes were documented and known by staff. Special diets were available as needed. Staff said they sought the dietitians advice when necessary. Drinks and snacks were available through both the day and night time hours. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had access to the homes complaints procedure and were protected by the homes safeguarding processes. Evidence: Visiting relatives and some people living at the home were able to describe how they would raise concerns with staff. Several commented that minor concerns they had raised had been dealt with promptly by staff and they were satisfied with the outcome. The complaints procedure was available for people living at the home, relatives and staff. People commented Ive lived here for four years now and theres nothing to complain about, the cares excellent, I did tell my carer about my laundry problem, it was sorted out with no problems, We are very happy with the care mum gets and have no complaints at all. The home kept detailed records of complaints received, their investigation, outcome and any changes made as a consequence. One safeguarding adults referral had been received since the last inspection, the final outcome was awaited at the time of the site visit. The allegations of poor practice lacked foundation although concerns about some staffing shortfall had been accepted by the homes management. These shortfalls had been caused by staff failing to Care Homes for Older People Page 16 of 26 Evidence: provide adequate notice for replacement staff to be found. This had been addressed by the homes management. Staff had been provided with training in adult safeguarding procedures to ensure people were kept safe, and to inform staff what to do if an allegation was made. Our discussions with staff confirmed that they felt confident and able to respond to peoples concerns or complaints effectively. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and homely environment. Evidence: We saw that the home was clean and smelled fresh. Pictures, soft furnishings and ornaments had been used to provide a homely domestic setting. Bedrooms visited had been personalised reflecting the interests and personality of the person who lived there. Some people had brought treasured possessions and memorabilia from their own homes. Bedrooms had been provided with matching curtains, bedding and soft furnishings. A range of colours had been used to individualise and improve the appearance of bedrooms. Bedrooms were lockable with keys available for those who wished to exercise the choice to lock their own door. Work in progress at the time included redecoration and refurbishment of a number of bedrooms. New carpeting and furniture had been provided in some bedrooms. Additional items of furniture and decor were tired and in need of updating. There was level access throughout the home with handrails provided to assist people to maintain their independence and mobility. We saw that storage facilities for Care Homes for Older People Page 18 of 26 Evidence: wheelchairs was limited but did not present a safety risk to people. Some bathroom and toilet areas were identified as needing updating, their appearance was clinical and not homely. The sluice areas had been identified for updating by the homes management. The laundry area was tidy. These areas were secured to protect people from accidental injury. The gardens appeared to be well maintained and attractive. They were easily accessed with seating that people said they enjoyed when the weather was fine. Visitor comments included, Its very clean and homely here and Im very happy with the the cleanliness. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who lived at the home were protected by the homes recruitment and selection procedures. Evidence: We met with nine members of staff during our visit to the home. We saw staff working with people and noted there was an atmosphere of mutual respect; their conversations were relaxed and friendly. We saw that minimum staffing levels had not been maintained consistently due to unexpected staff absences. Staffing levels had improved since the last inspection. Staff confirmed that they now had time to meet peoples needs and that problems only occurred when staff rang in without warning if they were ill; they said management did take action to maintain staffing numbers. The staff group were well motivated and enthusiastic about their work. They confirmed they had been supported and encouraged to train and update their skills. We sampled staff files and saw that the home follows the company safe recruitment procedures. They contained application forms, written references and criminal records bureau checks. Care Homes for Older People Page 20 of 26 Evidence: Records of staff supervision and training needs were examined. We saw the staff training and development plan. Training courses completed and planned were see. These included health and safety, adult safeguarding, moving and handling, first aid and dementia care. Many staff had achieved national vocational qualifications (NVQs); the remaining staff were working to achieve the award. Skills for the prevention of infection and fire and health and safety were updated each year. This ensures staff were trained to meet peoples care needs safely. Care Homes for Older People Page 21 of 26 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. People were protected by the management structure and systems in place. Evidence: Staff said the manager was approachable, very professional and they felt confident in her. The manager had a job description that clearly defines her role and responsibilities and staff were aware of her role. We saw that there was always a senior member of staff on duty at the home with advice and support readily available. responsibilities for the day to day operation of the home were shared between senior members of the team. People said I feel the home is very well run, they organise events for residents, Theyve changed my dads life since he came to live here. Staff had received management supervision at regular intervals; this is needed to develop staff and monitor care practices. Care Homes for Older People Page 22 of 26 Evidence: A senior company manager visits the home to monitor care and standards at the home. A written report of their findings was available at the home. Management use a quality assurance system to measure standards of care and service provided. Questionnaires were used annually to seek the views of people and their relatives. Regular meetings were held for staff and people who live at the home. These give people living at the home a voice and chance to say how the home should be run. People felt their views and opinions were taken into account by the staff. The manager handles money on behalf of some people, account sheets with receipts were kept. A second person witnessed each transaction. Records were mainly up to date and well ordered. The manager had commenced reorganising staff files. No fire exits were obstructed. Service records for the moving and handling equipment, fire safety records and other maintenance records were up to date, to maintain a safe environment for people living at the home. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 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 Care Homes for Older People Page 25 of 26 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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