Care Home: The Ledbury Home

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What the care home does well People have access to good information about the home. Senior staff from the home carry out assessments before people move in, so that the home can be sure that the staff can provide the care that people need. People can be confident that their health and personal care needs will be met by competent and skilled staff. Staff provide care in a way which promotes people`s privacy and dignity. The home provides a range of social and leisure opportunities, which are planned around people`s individual needs and wishes. Meals are appetising and provide a nutritious and balanced diet. People can be confident that their concerns will be listened to and taken seriously. The home has shown that complaints and concerns are resolved. Staff receive training which gives them the skills and knowledge they need to protect vulnerable people. The Ledbury Home provides a safe and comfortable environment for people to live. Infection control is well managed. Staff have the skills and knowledge to carry out their roles to a high standard. The home provides a range of training to give staff the skills and knowledge they require. People living at the home are positive about the staff. Comments included "the staff are marvellous", "they work hard and I don`t know how they stay so cheerful". The home is managed in the best interests of the people who live there. People can be confident that the manager runs the home efficiently and effectively. What has improved since the last inspection? Care plans and risk assessments contain consistent information and are regularly reviewed. The complaints procedure is given to everyone when they move into the home. Staffing levels are monitored and the home has contingency plans to make sure that there are always enough staff on duty to meet the needs of the people living at the home. What the care home could do better: Medication is not always accounted for accurately, and this means that the home cannot be sure that everyone has received their medication as prescribed. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Ledbury Home Market Street Ledbury Herefordshire HR8 2AQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sarah Blake     Date: 0 2 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: The Ledbury Home Market Street Ledbury Herefordshire HR8 2AQ 01531637600 01531637619 Telephone number: Fax number: Email address: Provider web address: www.shaw.co.uk Name of registered provider(s): Shaw Healthcare (Ledbury) Limited care home 36 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Age: Physical Disability (PD) age 55 and above The maximum number of service users who can be accommodated is: 36 The registered person may provide the following category of service only: 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 (OP) 36 Physical Disability (PD) 36 Date of last inspection Brief description of the care home The Ledbury Home provides nursing care for up to 36 older people. The home is situated within the Ledbury Community Care Centre in the heart of the town. The Care Homes for Older People Page 4 of 27 Over 65 36 0 0 36 Brief description of the care home majority of people who use the service are local and many have lived in the Ledbury area all their lives. The service has a strong identity in the town and is perceived as a local resource. This purpose built centre houses a number of separate services including Social Services, various dental, medical and therapy services, a minor injuries unit, an intermediate care unit (ICU), and an acquired brain injury (ABI) unit. The Ledbury Home is registered to offer services to people aged 65 and over with needs relating to general frailty. The Ledbury Home has two separate areas. On the second floor there are 19 single bedrooms, each with ensuite facilities, plus two communal sitting and dining rooms. On the first floor there is similarly set out accommodation for 17 people, but as the building follows the sloping contours of the land, some rooms look out at ground floor level. The main access to the home is at the first floor level and there is a lift providing access to both floors for people with mobility problems. A schedule of fees is available from the home. A copy of this report can be viewed at the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection. One inspector spent a day at the home, talking to the people who use the service and the staff, and looking at the records, which must be kept by the home to show that it is being run properly. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. We looked in detail at the care provided by the home for three people. This included observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. The service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the Care Homes for Older People Page 6 of 27 service. Some of the managers comments have been included within this inspection report. The information from these sources helps us understand how well the home is meeting the needs of the people using the service. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 Care Homes for Older People Page 8 of 27 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to good information about the home. Senior staff from the home carry out assessments before people move in, so that people can be sure that the staff can provide the care that they need. Evidence: The home has a Service User Guide which is made available to anyone who is considering moving into the home. The Service User Guide includes detailed information about the home and how it is managed, including details of how to raise any concerns. This information is presented clearly, and can be provided in large print, Braille or audio cassette, also in other languages and in symbols. This shows that the home recognises the various communication needs of people who might wish to live there. We spoke to people who live at the home and their relatives, and they told us that they had been given enough information to help them make an informed decision Care Homes for Older People Page 11 of 27 Evidence: about moving into the home. One person told us that they had visited the home and found the staff to be very welcoming. We looked at the records for one person who had recently moved into the home. The records showed that senior staff from the home had visited the person before they moved in, and had carried out an assessment of their care needs. We saw that this assessment included information which would help staff to be able to provide the right care as soon as the person moved in. For example, the person was using equipment to help them to move about easily, and the assessment explained clearly what this equipment was and when it should be used. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their health and personal care needs will be met by competent and skilled staff. The home generally manages medication safely, but there are some shortfalls in record keeping. Staff provide care in a way which promotes peoples privacy and dignity. Evidence: The home provides personal and nursing care for up to thirty-six people who have a range of care needs. We looked at records for three people who live at the home and spoke to staff who care for them, so that we could see how the home was meeting their individual needs. The records showed that the home plans peoples care by involving them or their families wherever possible. This means that people can retain as much independence as possible, and helps to ensure that their needs and wishes are part of care planning and review. We saw that the home carries out assessments for any area where there might be a Care Homes for Older People Page 13 of 27 Evidence: risk of harm or injury. For example, one person who is at risk of falling had an assessment which showed clearly what the risks were and how the home would manage them. The home had identified that the person was at risk of falling out of their chair, so staff had been instructed to use a lap strap whenever the person was in their chair. The records included clear instructions on the use of the lap strap. This is important because lap straps can cause injury. We saw that the person was supported in their chair with the strap positioned correctly. Care plans are written in a person-centred way, which places each individual person at the heart of care planning, and makes sure that their individual needs and wishes are recognised. Throughout the care plans, we saw evidence that the home places great importance on dignity and giving people choices. One care plan stated explain to A (name of person) before delivering any personal care choices to be given to A (name of person) about personal care. We saw that people had been asked about whether they preferred male or female care staff, and that this choice was respected where possible. People told us that the home always requests medical advice when necessary. Records showed that the GP visits regularly, and that other specialist healthcare professionals, such as the Parkinsons nurse, provide advice and support as necessary. We looked at medication records for some of the people living at the home. Complete and accurate records are important so that there is a full account of the medication the home is responsible for on behalf of the people living here, and so that people are not at risk from mistakes, such as receiving their medicines incorrectly. We looked at a sample of these records in more detail and these generally appeared to be in order, but we identified some weaknesses where improvements were needed. We were concerned that an audit check of records and stock of some paracetamol 500mg tablets indicated that 16 tablets were not accounted for. This needs investigation. The audit check also identified that some other medications had not been accurately accounted for. This could mean that people might not have been given the medication that has been prescribed for the. The arrangements for storing controlled drugs complied with the Misuse of Drugs Safe Custody regulations. However, the controlled drugs cabinet was untidy and contained large amounts of medication which should have been disposed of at least two months previously. In view of the findings from this inspection, regular and effective audit arrangements are needed to monitor that there is safe management of medication in the home. When we told the manager about the shortfalls in the management of Care Homes for Older People Page 14 of 27 Evidence: medication, she immediately took steps to rectify the situation. She has since written to us to explain how she will make sure that medication is managed safely in the future. During the inspection, we saw staff treating people with respect and making sure that any personal care tasks were carried out in ways which promoted privacy and dignity. Care Homes for Older People Page 15 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a range of social and leisure opportunities, which are planned around peoples individual needs and wishes. Meals are appetising and provide a nutritious and balanced diet. Evidence: The home makes sure that there is a wide range of social and leisure opportunities, so that everyone can find something which interests them. We spoke to the activity coordinator, who explained that there is a weekly programme of organised activities, which is supplemented by other, less structured, activities and one to one pastimes. We saw that the activities included Tai Chi; an Extend exercise class; day trips, including a recent canal boat trip with people from the Acquired Brain Injury Unit; craft sessions linked to the seasons; and weekly music sessions. The activity co-ordinator told us that she has begun to set up a memory book as a resource for the whole home. We saw some pages which had been completed: one was a beautifully illustrated description of someones memories of bird watching as a child, and one was a description of how important gardening is to another person. The co-ordinator explained that activities or chatting often trigger memories for people, Care Homes for Older People Page 16 of 27 Evidence: and she is trying to capture those memories so that everyone can share in them. The garden contained colourfully planted patio pots, and we were told that one person enjoys planting the pots and enters the Ledbury in Bloom competition each year. We saw fabric butterflies and bees which had been made during craft sessions, and would be used to decorate the plant pots. On the morning of the inspection, volunteers from the local community were holding a coffee morning for people living in the home and their families. There was a happy, relaxed atmosphere as people chatted and enjoyed each others company. In the afternoon, a music session was being held in the garden, as it was a sunny day. We saw that the home provides sun hats and parasols to protect people from the harmful effects of too much sun. The home provides care for many people who are too ill to leave their bedrooms, and the activity co-ordinator makes sure that she visits people in their rooms, and involves them in activities wherever possible. We saw a selection of scented plants on a trolley, and the co-ordinator told us that she takes these plants to peoples bedsides, so that they can smell the plants and feel the texture of the leaves even if they are unable to go out into the garden. The home provides a nutritious and well balanced diet for everyone who lives there, and caters for people with specialist dietary needs, such as diabetes. On the day of the inspection, we saw that lunch was pork and apple casserole, with broccoli and carrots; or beef curry; or a vegetarian option of cheese, leek and potato pie. The food was served from a hot trolley, and appeared appetising. People told us that they enjoy the food at the home. One person said that it was excellent and a relative told us its very good, they always get a choice. We saw staff supporting some people to eat, and this was done respectfully and in an unhurried manner. Care Homes for Older People Page 17 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their concerns will be listened to and taken seriously. The home has shown that complaints and concerns are resolved. Staff receive training which gives them the skills and knowledge they need to protect vulnerable people. Evidence: In the AQAA, the manager told us all complaints are dealt with efficiently and in line with the policy. We saw that records showed that all concerns and complaints are investigated, and any action is taken in within appropriate timescales. We, the commission, have not received any complaints about the home within the past year. The complaints procedure is part of the Service User Guide, which is give to everyone when they move into the home. It is also displayed on the notice boards in the home, and contains up to date information. People told us that they know how to complain and that they were confident that they would be listened to. One person said theres no reason why I shouldnt talk to anybody - theyre all helpful. The home has policies in place to tell staff how to protect people from neglect or abuse. We spoke to staff, who showed a good knowledge of the principles of the protection of vulnerable adults, and told us that training in this forms part of their induction. Records showed that staff had received training in this area. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Ledbury Home provides a safe and comfortable environment for people to live. Infection control is well managed. Evidence: The home is purpose built and is situated in a quiet part of Ledbury town. All the bedrooms are single rooms, with en-suite showers and toilets. There are also bathing facilities on each floor, including assisted baths for people who need support when bathing. The bedrooms were seen to be clean and tidy, and some people had brought their own ornaments and small items of furniture to make their bedrooms more homely. Each floor has a lounge and dining room, and these are light and airy. The lounges have armchairs which are arranged so that it is easy for people to chat together. Some of the armchairs in the upstairs lounge are grouped around the large windows, which give a good view over the town to the countryside. The dining rooms have a small kitchenette area, where people can make drinks or snacks. Throughout the home, there is plenty of space so that people in wheelchairs can move easily around the home. There is a lift and a staircase between the two floors. Care Homes for Older People Page 19 of 27 Evidence: People told us that the home is always kept clean. One person said its always nice and clean, and it smells fresh. The cleaners work hard. On the day of the inspection, we saw that staff were using gloves and aprons appropriately, and that infection control measures, such as liquid soap and paper hand towels, were in place throughout the home. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have the skills and knowledge to carry out their roles to a high standard. The home provides a range of training to give staff the skills and knowledge they require. Evidence: During the inspection, we saw that staff were kind and caring in their approach to people living at the home. This confirmed what people told us. Comments included the staff are marvellous, they work hard and I dont know how they stay so cheerful and excellent, no other word for it. People told us that there are always enough staff on duty. The Service User Guide tells people how many staff should be on duty, and the rotas showed that this level of staffing is maintained. We spoke to staff, who showed a good knowledge of the needs of the people they were caring for. Records showed that staff receive a range of training to give them the skills and knowledge they need. In the AQAA, the manager told us that the home encourages professional development for all levels of staff, and staff told us that they felt that the training provided by the home was excellent. One member of staff said the training here has been wonderful. The manager told us that the home plans to expand the training on offer by using Care Homes for Older People Page 21 of 27 Evidence: distance learning to cover topics such as dementia awareness, equality and diversity and palliative care. We looked at records for two new members of staff. These showed that all the checks required before people can start work were carried out. These include a Criminal Records Bureau (CRB) check and two written references, one of which is from a previous employer. These checks help to make sure that only suitable staff are employed. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in the best interests of the people who live there. People can be confident that the manager runs the home efficiently and effectively. Evidence: The manager and her deputy work closely together to make sure the home runs smoothly. The manager is registered with the commission. This means that she has been judged to have the skills and knowledge necessary to run the home. Staff at the home told us that the managers are supportive and approachable. On the day of the inspection, there was a purposeful and friendly atmosphere within the home, and we saw that people living at the home and their families obviously knew both the manager and her deputy, and felt at ease with them. We saw detailed reports of visits to the home by representatives from Shaw Healthcare, and these included action points to address any shortfalls. Care Homes for Older People Page 23 of 27 Evidence: The home does not take responsibility for peoples personal finances, although there are procedures in place for this to happen if it is unavoidable. The home has good procedures for managing health and safety, and the manager clearly takes her responsibilities in this area very seriously. One member of staff told us about an incident when she had felt that more assistance was needed to ensure her safety in carrying out a task, and this assistance was provided immediately. Throughout the inspection, people were very positive about all aspects of the home, and one relative summed up her feelings as Im glad my husbands in here, I know hes well looked after. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 (2) You must ensure that accurate medication audits are carried out. This is to ensure that people receive their medication as prescribed. 22/07/2009 2 9 13 (2) You must ensure that medication which is no longer required is disposed of in a timely manner and in accordance with good practice guidelines. This is to ensure the safety of people who use the service. 22/07/2009 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 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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