Care Home: The Old Rectory

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What the care home does well People told us they were supported to visit the service and to make an informed choice about their future and about moving into the service. They told us they received `lots of help and support during this difficult and often emotional time` People told us they chose this service due to its `homely atmosphere and relaxed setting`. People said the routines were flexible and they chose how they wish to spend their day. People told us they are "well looked after". They told us the staff team were: "splendid, helpful, caring, friendly, marvelous and provided care the way they wanted it". People told us the provider was "very approachable and pro-active with dealing with any issues". They felt able to go to him with any issues and were confident he would address any issues raised. People liked the food provided and told us they have many choices, at all times. People told us they were "happy and satisfied with living at this service", which they said "meets all of our needs" What has improved since the last inspection? The provider has addressed all of the outstanding requirements from their last inspection report. The care plans are now more detailed and include peoples preferences to make sure people receive person centered care. The care plans cover all of the person`s needs including health needs which link in with the required risk assessments. The storage of medication has been improved and a new trolley purchased. All staff that administer medication have received training and have been observed to ensure they undertake these tasks safely. People have access to recreational activities of their choice and preference. A new activities staff member has been recruited to facilitate activities and to undertake one to one work with people with high dependency needs. A record is now in place and full details of any complaints received and how they have been responded to are recorded. A renewal programme is in place with timescales. During our visit we noticed areas that have been renewed in accordance with this programme. The provider regular reviews the staffing and deployment of staff and additional staff have been provided during peak times when it is busy. The recruitment of staff has improved and all of the required information is nowobtained to ensure the candidate is suitable to work with vulnerable people. Training has been arranged for staff to access training around the requirements of the mental capacity act. This will provide staff with the knowledge and skills to support people to make decisions about their lives. What the care home could do better: We have made one requirements following this visit. This is in relation to ensuring hand washing products are located in all toilets areas, which are accessible for people to use. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Old Rectory 70 Risley Lane Breaston Derby DE72 3AU     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: Claire Williams     Date: 1 3 0 5 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 28 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 28 Information about the care home Name of care home: Address: The Old Rectory 70 Risley Lane Breaston Derby DE72 3AU 01332874342 01332873826 asheathuk@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Allen William Heath care home 26 Number of places (if applicable): Under 65 Over 65 26 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 The Old Rectory is a detached property situated in the village of Breaston. It is situated 300/400 yards from the village centre and from a main bus route. The Service is registered to provide personal care for 26 older people of either gender. There are both single rooms and double rooms available on the ground and first floors. The first floor rooms can be accessed by both a shaft lift and stair lift. The home has five small lounge areas that can be used for a variety of different purposes; one is used as a hairdressing room. The home operates a no smoking policy. Information provided at this visit stated that the scale of fees was £345 - £385 per week. Information provided in the Statement of purpose and Service user guide indicates what this includes. Inspection reports are were available upon request from the provider. Care Homes for Older People Page 4 of 28 Care Homes for Older People Page 5 of 28 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 inspection was unannounced and involved a visit to the site on 13th May 2009 which lasted for a period of a day. The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who use the service and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Where possible, we include evidence from other sources, notably District Nurses and Social Workers. We also use information gathered throughout the year, to support our judgments. This may include notifications from the provider, complaints or concerns Care Homes for Older People Page 6 of 28 and the pre-inspection annual quality assurance questionnaire, which the provider is required to complete prior to a visit to the service. The main method of inspection used during the visit to this service was case tracking. This involved selecting three people who use the service and tracking the care they receive through the review of their records, discussion with them where possible, the care staff and observation of care practices. We looked at all of the key standards during our visit. What the care home does well: What has improved since the last inspection? The provider has addressed all of the outstanding requirements from their last inspection report. The care plans are now more detailed and include peoples preferences to make sure people receive person centered care. The care plans cover all of the persons needs including health needs which link in with the required risk assessments. The storage of medication has been improved and a new trolley purchased. All staff that administer medication have received training and have been observed to ensure they undertake these tasks safely. People have access to recreational activities of their choice and preference. A new activities staff member has been recruited to facilitate activities and to undertake one to one work with people with high dependency needs. A record is now in place and full details of any complaints received and how they have been responded to are recorded. A renewal programme is in place with timescales. During our visit we noticed areas that have been renewed in accordance with this programme. The provider regular reviews the staffing and deployment of staff and additional staff have been provided during peak times when it is busy. The recruitment of staff has improved and all of the required information is now Care Homes for Older People Page 8 of 28 obtained to ensure the candidate is suitable to work with vulnerable people. Training has been arranged for staff to access training around the requirements of the mental capacity act. This will provide staff with the knowledge and skills to support people to make decisions about their lives. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 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 28 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 information, which enables them to make an informed choice about moving into this service. Evidence: The provider told us in the information supplied about the service how they ensure peoples needs are assessed before they make a decision about their ability to meet these. They told us they try to ensure they provide a homely atmosphere, and encourage people to visit the service where possible. Information about the service was available, but the documents require updating to include the current fees and the name change of the regulator. People spoken to told us they were given a guide when they moved in. We spoke to people about their admission to the service and the following comments Care Homes for Older People Page 11 of 28 Evidence: were made: I moved here because it is homely and I like the small lounge areas we can use The staff were great when I moved in, they were very helpful and supportive; it was a hard decision to make leaving my home. People told us they felt their needs were met by the service, and they confirmed they had been assessed before they moved in. Records seen confirmed this. Care Homes for Older People Page 12 of 28 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. Each person has a plan of support which covers their personal, health and social care needs. This ensures support is provided based on their preferences. Evidence: The provider told us in the information supplied about the service how they consider the opinions and views of people and complete individualised care plans. He said the care plans are person centered allowing staff to deliver a more focused approach to individualised care. This evidence was supported by the three care files that we looked at. These were completed in a person centered way, so that staff are informed of the individuals preferences when providing support. The information provided included peoples preferred daily living, personal care routines, and their support needs throughout the night. This ensures people receive individualised care which meets their expectations. Each care plan that we sampled contained the required risk assessments that should Care Homes for Older People Page 13 of 28 Evidence: be undertaken to monitor peoples mobility, pressure areas, nutrition and falls. These were reviewed as required. The care records that we sampled and discussions with people confirmed that contact with external health care services is routinely made. During our discussions we spoke about people having their weight monitored and people told us that they were supported in this area. However some individuals told they refuse this support due to not feeling confident enough to stand on the scales due to their mobility difficulties. There was evidence in the files to support that the plan of care is reviewed on a regular basis when peoples needs change and as part of the formal annual review. However the plans were not routinely reviewed on a monthly basis in accordance with the standards. When we identified this shortfall, action was taken to implement the required reviewing system. Visitors we spoke to told us they are invited to these reviews with their family members permission. They also told us they were more than happy with the care provided to their relative. Another comment we received was: My relative has improved while they have been living here, they look much better, eating better and they seem to have a better quality of life, we are very happy. All of the people we spoke to told us they receive support which is provided in a safe, respectful and dignified manner, and our observations, supported this. When we looked at the arrangements for the handling and management of peoples medicines by the service, we found these to be satisfactory and people were receiving their medication as prescribed. The provider regularly audits the medication practices and includes his findings in his monthly report. Care Homes for Older People Page 14 of 28 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 find the lifestyle experienced in the service meets their expectations and preferences. Evidence: The provider told us in the information supplied about the service how they aim to ensure the daily life within the home is flexible so that people can move around freely. He told us he has now recruited a full time activities co-ordinate and motivator who has started arranging events, outings and church services. He said that they encourage people to celebrate their birthday in the home by having parties and events to make it a special occasion. The files we looked at contained information about peoples social needs and likes and dislikes. This enables the staff team to provide recreational activities based on peoples preferences. People told us about the new activities staff member, and how she has started to consult them about what kind of activities they would like to participant in. People told us we have enough to do, but I am looking forward to some outings in the future that will be good. Care Homes for Older People Page 15 of 28 Evidence: People told us they liked the flexibility of being able to choose what they wish to do during the day. Some individuals told us how they like being in their rooms because they are a loner and how this is respected. One person told us how she has started a knitting group, which she really enjoys facilitating and they hope to knit a blanket for the home. A list of activities was displayed in the service. During our visit the activities coordinator was not on duty, but staff consulted individuals and they chose to have music played. People were observed singing and one person brought a favorite CD from her room to play. We joined people for their lunch-time meal. The tables were set with tablecloths and condiments so people could help themselves. People told us they have choices, at each meal time and observations supported this. We undertook a brief tour of the kitchen and the cook told us she was aware of peoples dietary requirements. Some information was available in peoples files of their food preferences. Care Homes for Older People Page 16 of 28 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. Systems in place ensure people have confidence to raise their concerns, and are safeguarded from harm. Evidence: The provider told us in the information supplied about the service how they log all complaints received and ensure they are responded to as soon as possible. During our discussions with people they told us they knew how to complain and they said they would not hesitate to raise any issues with the staff team or provider. Relatives also told us if they had any cause for concern they would go straight to the provider or the acting manager. They told us they had confidence that any issues raised would be addressed immediately. People are able to access the procedure for complaints as it is displayed in several areas of the home, and in the service user guide. We looked at the complaints record and the service had received 13 complaints since our last visit. The issues raised include some of the following: food, toilet being soiled, carpet soiled, lost laundry, temperature of the heating and hot water. Each complaint had been investigated and the responded to within 28 days and feedback provided to the complainants. All complaints are now closed. Care Homes for Older People Page 17 of 28 Evidence: Staff members spoken with were conversant with the homes complaints procedure and their role and responsibilities concerned with dealing with complaints. They also told us they had received training in relation to recognising abuse and safeguarding people from abuse. The staff members were conversant with internal procedures to follow in the event of the suspected or witnessed abuse of any service user, and they understand the role of external agencies. A copy of the Multi-agency Safeguarding adults procedures was available in the service. Care Homes for Older People Page 18 of 28 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 benefit from living in a clean, and safe building that is homely in design and meets their needs. Evidence: The provider told us in the information supplied about the service that he provides a good homely environment and ensures the furniture and decoration are maintained to a good standard. He told us the building has many lounges so people can move freely around the home, and he employs someone to ensure the garden areas are well presented. We undertook a brief tour of the building and found all communal areas to be clean, comfortable, homely, warm and well lit. All areas were furnished and decorated to a satisfactory standard. We did identified some toilets that did not have any soap available to enable people to wash their hands. This is an essential requirement as part of the infection control practices. We also noted that the paper towels and toilet roll were placed on the back of the toilet, which means it could be difficult for people who live in the service to access these. The provider did agree to address this issues, and soap was placed in the downstairs toilets during our visit. Care Homes for Older People Page 19 of 28 Evidence: People told us they really liked the homely feel of the environment and especially the original fireplaces and features as part of the building is listed. They told us they were satisfied with their environment, which they said suited their needs. People had access to equipment which encourages and promotes their independence. We visited the bedrooms of the people whose care we looked at more closely and we found these to be well maintained, and personalised with their personal possessions. People told us they are offered a key to their room when they move in and some individuals we spoke to have been provided with a key. People told us they made good use of the garden in the summer and were looking forward to this. People had access to the required aids and equipment to assist them to mobilise around the building. We did see a range of equipment during our tour including an assisted bath. We did note that some of the bathrooms areas appeared to be cluttered, and could be potential trip hazards. Care Homes for Older People Page 20 of 28 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 are supported by a competent staff team, who have been recruited to ensure they are safeguarded from any harm. Evidence: The provider told us in the information supplied about the service that all staff are trained in all mandatory training on an annual basis. They have improved their recruitment procedures to ensure they are in accordance with the legislation. During our visit we observed that sufficient staff members were working, to meet peoples dependency needs. People and their relatives told us that enough staff was available at all times. People, and their relatives commented positively about the standard of care provided and comments made included: The staff are very caring and dedicated to their roles. The staff are great, friendly and they are good at what they do. I dont think I could be looked after better than what I am here, I am very satisfied with the care I receive from the staff. Care Homes for Older People Page 21 of 28 Evidence: Discussions with staff members confirmed that the staffing levels are sufficient to enable them to meet peoples needs and provide care in a relaxed way. The staff team demonstrated their commitment and motivation to ensuring people have a good standard of care. We was unable to access the training records for staff on the day due to the acting manager not being on duty. However we was sent evidence of the training staff members had completed the next day. This and the information provided in the AQAA and staff discussions demonstrated that staff receive positive training opportunities. Regular training ensures staff members have the required skills and knowledge for their role. We looked at the recruitment information for three staff, which included two of the most recently employed staff members. All of the required information was available and the required checks had been undertaken to ensure these individuals were suitable for their role. We were provided with information to support that new staff members are provided with an induction to assist them to gain the required skills and knowledge for their role. Care Homes for Older People Page 22 of 28 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 Health, safety and welfare of people and staff is promoted and protected in this service. Evidence: The provider told us in the information supplied about the service that he regularly undertakes audits as part of his unannounced monthly visits to the service, to ensure standards are being met in all areas. He told us he intends to recruit a manager, and two senior staff to formalise the management team. The service continues to keep us informed of any significant events that have occurred. They completed their self assessment within the timescale provided and the information provided was detailed and comprehensive. We received many positive comments about the provider and his wife who is currently the acting manager for this service. Staff, people, and relatives spoken to told us they Care Homes for Older People Page 23 of 28 Evidence: found them to be approachable and supportive. We were told that the provider is proactive and addresses any issues quickly. The staff members told us they thought the service was well managed and they felt supported by the acting manager and provider. The staff told us they felt valued and that everyone worked as part of a team. Some of the comments we received from people and their relatives included the following: I think the provider is lovely, and a very approachable person, he comes and asks me what I think about living here, and I tell him the truth. He accepts all that I say good and bad, and always deals with any issues I have. He works very hard at making sure our needs are met, which they always are to a good standard. I think the provider is very approachable, anything I ask for is provided regardless of what it is. He is very helpful, and I have often seen him helping the staff and supporting people. The provider and his wife are great and very professional. Whenever I ask for money they always ensure two staff are present to witness and sign any transactions; I think this is good, I am very happy here, and all of my needs are met. People told us they have recently been given a quality assurance questionnaire to complete to provide feedback about the service. People also told they felt well consulted about aspects of the service provision. We received evidence to support that staff have access to regular supervision, which provides them with ongoing support and direction in their role. Staff members also confirmed this during our discussions. Staff spoken with described satisfactory arrangements for ensuring safe working practices by way of training and provision of equipment. We looked at the systems in place for looking after peoples money and when checked these were found to be satisfactory. A new system was implemented to ensure people can access their money at all times, as previously they could only access their funds if the provider or his wife were at the service. We looked at the reports which are completed following the providers monthly visits. These were found to be detailed and informative. Care Homes for Older People Page 24 of 28 Care Homes for Older People Page 25 of 28 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 26 of 28 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 21 13 The toilets must contain soap at all times. This is to enable people to wash their hands, and prevent the spread of infections. 20/06/2009 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 1 8 A system should be in place to ensure all people can be supported to monitor their weight and be weighed on a regular basis. All toilets should have a bin located inside to enable people to dispose of paper towels. The hand towels and toilet roll should be made accessible and mounted on the wall so people can reach and use them. The bathroom areas and lounges upstairs should be cleared of all items that are not required to ensure a clear space is provided for people to move about in. It would be beneficial to the service to have a registered manager in place for this service. 2 3 21 21 4 26 5 31 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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