Care Home: The Old Rectory

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What the care home does well Staff were seen to be kind and caring at all times. Residents were encouraged to maintain their links with friends and family and all visitors were made welcome. People living at the home liked the food provided and enjoyed the choices offered at each meal. The house and gardens were maintained to provide residents with a comfortable place to live. Residents were encouraged to personalise their rooms with items of furniture, pictures and a variety of mementos. Sufficient numbers of staff were on duty throughout the day and night to be able to meet the needs of the residents. What has improved since the last inspection? The complaints procedure reassured residents that their views were important to the home and that any complaints they raised would be properly investigated. The last key inspection identified a need for a second sluice. This is now in place and its use reduces the risk of cross infection. What the care home could do better: The home needs to appoint a manager who submits an application to the Care Quality Commission to register. Care documentation needs to be developed and care plans should be specific and person centred. This will help to ensure that each resident gets the care and support they need. The procedures relating to medication need to be improved so that people living at the Old Rectory can be sure that they get the medicines they need in a safe manner. The quality assurance tool used by the home needs to be improved so that the management team identify any shortfalls in service and act promptly so that the home is run in the best interests of the people living there. When the management team highlight a need of staff supervision they should ensure that this is carried out. This will help to make sure that residents are cared for by suitable staff, who have the appropriate skills to care for this client group. Key inspection report Care homes for older people Name: Address: The Old Rectory The Old Rectory Langton Matravers Swanage Dorset BH19 3HB     The quality rating for this care home is:   one star adequate 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: Amanda Bell     Date: 0 5 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: The Old Rectory The Old Rectory Langton Matravers Swanage Dorset BH19 3HB 01929425383 01929425396 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: DAH Healthcare Ltd care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: A maximum number of 23 service users who require nursing care may be accommodated. The maximum number of service users who can be accommodated is 34. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home The Old Rectory is situated in the centre of Langton Matravers, a rural village on the outskirts of Swanage. The village has a Post Office, newsagents, bakery, public house and church. There is a bus stop outside the home. The home is registered to accommodate a maximum of 34 people in the category of Care Home with nursing. A maximum of 23 people with nursing needs may be accommodated. Certain rooms, known to the owner and manager, may only be used for residential care, as they are Care Homes for Older People Page 4 of 25 Over 65 34 0 Brief description of the care home too small to support good nursing care practice. Three rooms are registered as doubles. Accommodation is arranged on the ground and first floor levels in twenty eight single rooms and 3 double rooms. All of the rooms have ensuite facilities. There are two passenger lifts to the first floor enabling level access to all but four bedrooms. Fees at the time of the inspection ranged from £595 to £695 Care Homes for Older People Page 5 of 25 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: one star adequate 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 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection took place on the 21st September and the 5th October 2009 over a period of approximately seven hours. The purpose of the inspection was to assess all of the key standards. The inspection was carried out by one inspector but the term we is used throughout the report to reflect the findings of the Care Quality Commission, (CQC). The Clinical Director was on hand throughout our visit to aid the inspection process. The acting manager was on duty on the second day of inspection and fully cooperated with us. Information gathered for this report came from several sources including reports made Care Homes for Older People Page 6 of 25 to the Care Quality Commission by the home; discussion with people living, visiting and working at the home; a tour of the premises; review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. During the course of the inspection people were asked their views on the service provided at the home. They said: Staff are very kind. The Old Rectory provides a very family atmosphere and residents are well looked after. Care Homes for Older People Page 7 of 25 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. Care Homes for Older People Page 8 of 25 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 25 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 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering using this service are given sufficient information to enable them to make a choice about whether to live at the Old Rectory. A detailed assessment of their individual needs is completed before they move into the service. Evidence: People living at the home told us that they were given sufficient information about the Old Rectory before they made a decision about staying there. They told us that they met with a member of staff, who undertook a detailed assessment of their needs. They also told us that they and/or their families were encouraged to visit the home prior to admission. We viewed the care documentation for two people who had recently moved in. There were very detailed pre admission assessments in place, which gave staff sufficient information to be able to plan care accordingly. The manager had written to the prospective residents to say that the home would be able to meet their needs. Care Homes for Older People Page 11 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to provide staff with the information to care for residents. However care documentation needs to improve and be more person centred to ensure that each individual receives the care they need. Medication management needs to be improved to ensure it does not place people at risk of harm. Evidence: We reviewed the care documentation for three people living in the home. Each file contained a variety of risk assessments and the care plans were based on the information gained from them. However there were some shortfalls in the documentation. One care plan stated that the resident needed to be: Padded 24 hours with molicare large nappy pad and requires frequently checking. There was no mention of a toileting regime, which may have promoted the individuals dignity. Some care plans were generalised rather than person specific. Generally the documentation we saw covered all the necessary topics but would benefit from development to ensure that staff can provide for person centred care rather than perform tasks for the person. Care Homes for Older People Page 12 of 25 Evidence: During the inspection we also examined the medicine storage areas, medicine administration records, (MARs), and looked at information in peoples plans of care relating to medicines. The MARs showed us that generally people got the medication prescribed to them in a safe manner. There were areas of recording that needed to be improved. One resident was self medicating but there had been no risk assessment to ensure that all necessary support was in place so that the resident could do this safely. A handwritten chart had not been countersigned to ensure that administration instructions were accurate. Eye drops, with an active life of twenty eight days, were not dated when opened, therefore the staff could not be sure when to discard them. We observed that when medicines were stored in the designated refrigerator that it was not maintained within the temperature range as specified by the manufacturers of the medicines. This meant that these medicines may not work as they were intended, so may place people at risk of harm. During the course of the inspection we spoke with five residents and received comments through resident surveys. People told us: I am writing for my relative. I find the care home at the Old Rectory one of the best in Dorset. Staff are very caring and loving. The home provides a very caring family atmosphere despite being a large home with 33 rooms. All the staff are available when needed to discuss my mothers care and reassure me and her. We observed staff during their working day and found that they were kind, caring and respectful at all time. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the Old Rectory are encouraged to maintain as much independence as possible. Social and leisure activities are varied and suited to the preference and ability of most of the residents. Evidence: The home continues to develop a programme of activities which are based on the preferences of those living at the home. People told us that they enjoyed the activities on offer, which included musical entertainers, reminiscence sessions and a variety of games and quizzes. They also told us that they could choose to spend their time as they wanted to do. Some people preferred to spend periods of time on their own. During our inspection we heard much laughter coming from the lounge where a quiz was underway. It was evident that everyone was enjoying themselves. However the activities organisers hours were limited and some people expressed a wish that more staff hours were devoted to this aspect of life at the Old Rectory. People we spoke with told us that their visitors were always made welcome and that they could conduct their visits in private. One person said that the home Is extremely accommodating to visitors. We visit frequently and are always made most welcome. During our inspection we saw residents enjoying their lunch in the dining room. People told us they enjoyed the food and that the menu offered choice. Comments included: Care Homes for Older People Page 14 of 25 Evidence: The food is good and well presented. The food is very tasty. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, and have access to a complaints procedure. Protection from abuse is promoted. Evidence: People told us that they knew how to complain and felt confident that if they had concerns or complaints they will be listened to and taken seriously. One complaint had been received in the last year. Records showed us that the home had investigated it and taken appropriate action as a consequence. The home has developed and implemented written policies and procedures for the protection of residents from abuse or neglect and provides all staff with training in the understanding of abuse and their role in protecting residents from abuse in its many forms, including neglect. Care staff spoken with during the inspection confirmed that they had received such training. Care Homes for Older People Page 16 of 25 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 Old Rectory is a safe and comfortable place to live. Evidence: A tour of the premises and review of maintenance documentation showed us that the home was well maintained inside and out. There was evidence that equipment was serviced regularly. Residents had easy access to all communal areas. Individual bedrooms were of a satisfactory size and furnished appropriately. Bedrooms were personalised with a variety of mementos, pictures and small items of furniture. People living in the home told us that it was a comfortable place to live. Comments included: The home maintains a very high standard of cleanliness and hygiene. Cleanliness is good and very rarely are there any bad smells. The laundry continues to be well managed. Adequate supplies of clean linen were seen to be available. One person told us; The laundry is done efficiently and quite quickly. The bedding is always clean. Care Homes for Older People Page 17 of 25 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. Sufficient care staff are employed to meet the needs of residents. Robust recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. Generally staff are given the training and support so that they can give a good standard of care to the residents living at the home. Evidence: At the time of inspection staff rosters demonstrated that there were sufficient staff on duty at that time. During the inspection staff were on hand to meet the needs of the people living at the Old Rectory. Residents spoken with confirmed that staff were available when they needed them and they were not kept waiting. The home has an ongoing training programme, which includes NVQ level 2 and 3 in care. At the time of inspection approximately 50 percent of the care staff hold the minimum of a level 2 award in care. We reviewed three staff recruitment files. The files were well ordered and contained all the information required by law. POVA first and enhanced Criminal Record Bureau checks had been obtained for all new staff. We reviewed the training programme. Records showed us that staff were receiving induction training and staff we spoke with confirmed that they were encouraged to Care Homes for Older People Page 18 of 25 Evidence: take up training opportunities provided. Recent training included protection of vulnerable adults; moving and handling; dementia awareness and nutrition. It was evident through discussion with the people we spoke with that the staff were meeting their needs. Care Homes for Older People Page 19 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management of the home is sometimes weak and there is evidence the service does not always operate in the best interests of service users and has not protected them from risks of harm. Evidence: Mrs Thomas was in day to day charge of the home in her position as appointed manager. However, at the time of inspection she had not submitted and application to the Care Quality Commission to register as manager. Therefore standard 31 could not be fully assessed during this inspection. The home had some systems for quality assurance in place. Audits were undertaken for care plans, pressure sores, wound care and medication. However these were not robust enough to highlight the shortfalls in recording that we have seen at this inspection. The Clinical Director confirmed that residents were encouraged to retain control of Care Homes for Older People Page 20 of 25 Evidence: their own finances for as long as possible. Where they state that they no longer wished to or they lacked the capacity to do so then the home ensured that either family or other representatives such as solicitors took on this role. Small amounts of cash are held and records and balances for these were checked. We reviewed the supervision records for staff and found that only some staff had regular supervision. In one supervision record it was recorded that the member of staff needed more regular supervision and their performance was to be monitored. There was no evidence that this took place, which showed a lack of support to the individual concerned. Accident books were examined and found to be up to date and detailed. We looked at the homes fire safety policy, which stated that staff should receive training in fire safety twice a year. However the management team confirmed that fire safety training had not taken place since February 2008. This lack of essential training put people at risk. On our first day of inspection we made an immediate requirement that staff were trained in fire safety and this was carried out within the week. Care Homes for Older People Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 31 8(1) The provider must appoint a 31/10/2008 suitably qualified, competent and experienced person to manage the home and put them forward for registration with the Commission. 2 33 24(1) Further work must be 31/10/2008 undertaken with regard to quality assurance systems in the home in order to demonstrate that the home is meetings its aims and objectives and is run in the best interests of the residents. 15/08/08 This repeated for a fifth time but progress has been made. Care Homes for Older People Page 22 of 25 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 1 38 13 Staff must receive fire safety 30/09/2009 training. To ensure the safety of those people living and working at the home. 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 The Registered Person must ensure there are arrangements for the safe recording, handling, safekeeping and safe administration of medicines. To ensure that residents have the medicines they need. 31/12/2009 2 36 18 The Registered Person must 05/01/2010 ensure that staff are suitably supervised. To support staff in carrying out their duties and enabling them to provide a good standard of care. Care Homes for Older People Page 23 of 25 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care plans should be specific and person centred. Care Homes for Older People Page 24 of 25 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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