Care Home: The Poplars

What the care home does well The home provides a pleasant, homely and clean environment for people who live there. People gave positive comments about their care and services received, comments included, `it`s the next best thing to home` and `the staff are wonderful`. The visiting nurse told us she felt people are well cared for, staff carry out any instructions from her and always seek appropriate advice. People are able to take part in various recreational activities and maintain contact with family and friends as they wish, activities include, quizzes, exercise and art classes, poetry reading, one to one time, theatre trips and hand massage and manicures. Leadership in the home is good and quality monitoring systems are in place to ensure the home is run in the best interest of people living there. What has improved since the last inspection? The Statement of Purpose and Resident Guide have been updated and include a copy of our report and information about the current fee rates. Some bedrooms have been re-furbished and re-decorated and a summer house has been erected in the garden. Care plans have been re-written and are more person centred and staff have received training regarding the Mental Capacity Act. What the care home could do better: Care records should clearly show the level of involvement the person has in writing their plan of care. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Poplars Chapman Street Market Rasen Lincs LN8 3DS     The quality rating for this care home is:   three star excellent 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: Elisabeth Pinder     Date: 1 8 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 26 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 26 Information about the care home Name of care home: Address: The Poplars Chapman Street Market Rasen Lincs LN8 3DS 01673843319 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) : manager.poplars@osjctlincs.co.uk The Orders Of St John Care Trust care home 40 Number of places (if applicable): Under 65 Over 65 15 25 dementia old age, not falling within any other category Additional conditions: 0 0 The home is registered to provide personal care to service users whose primary needs fall within the following categories:- Old age, not falling within any other category (OP) - 25 and Dementia - over 65 years of age (DE(E) - 15 The maximum number of service users to be accommodated is 40. Date of last inspection Brief description of the care home The Poplars is a care home owned by the Orders of St John Care Trust; it is a purpose built single storey building located close to the town of Market Rasen. The home has 38 single rooms and one double room. The Poplars has a large secluded garden to the front and rear of the property, a large car park is provided at the front of the home. The care home provides care for forty people, twenty five being older people over 65 years of age and fifteen who have dementia. The home offers long term care and respite care. The homes service users guide states that it aims to provide a secure, relaxed and homely environment in which their care, well being and comfort are of prime importance. Care Homes for Older People Page 4 of 26 Brief description of the care home The current weekly fee is £419.00 - 595.00. Additional charges are made for chiropody, hairdressing, newspapers and personal toiletries. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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 visit and it formed part of a key inspection, focusing on key standards which have the potential to affect the health, safety and welfare of people who use the service. From 1 April 2009 the duties of The Commission for Social Care Inspection (CSCI) have been taken over by the Care Quality Commission (CQC), the new independent regulator of all health and social care in England. Throughout this report the terms we and us refer to the Care Quality Commission (CQC). The visit lasted seven hours and took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since our last visit. Before we made our visit the manager had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own Care Homes for Older People Page 6 of 26 assessment of how well they are meeting standards and their plans to improve aspects of the service. The main method used to carry out the inspection is called case tracking, this includes following the care of a sample of people through their care records and assessing their care. We spoke to people who use the service, three members of staff, the manager, the assistant operations manager and district nurse. Before our visit questionnaires had been sent to 4 people using the service and to 4 staff, those returned to us will be mentioned throughout this report. 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 7535. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People coming into this service have access to a range of information to help them make a decision about moving into the home and procedures are in place to ensure people are only admitted after a full needs assessment has been carried out. Evidence: Information sent to us prior to the inspection told us that people have access to a range of information about the service and are able to visit the home and spend time there before making a decision about moving in. Information is available in an information pack given to people on their initial inquiry, a Statement of Purpose and Service User Guide. The Service User Guide tells people how they can access a copy of the last inspection report and gives information about the current fee rates and where they can obtain independent advice should this be needed. It tells people how differing needs, such as religion and culture will be met and how the service considers the Mental Capacity Act. People living in the home also receive a copy of the Trust Care Homes for Older People Page 10 of 26 Evidence: magazine. Three surveys from people living at the home were returned to us before the visit and these told us they had received contracts/terms and conditions of residency and two identified enough information about the service had been received before their admission. Care records of two people who had recently been admitted were looked at and both showed that a needs assessment had been carried out. However, one of them was dated the same day as their admission and it was unclear when the assessment had been carried out. Letters confirming that after the assessment the service could/could not meet needs could not be found and the Assistant Operations Manager who was assisting with our visit agreed to make sure these are sent in the future. Both records included contracts/terms and conditions of residency. People told us they were happy with the home and the services offered, one person told us she had previously stayed for a period of respite care and had no doubts about moving in permanently saying, its the next best thing to home. The service does not cater for people with intermediate care needs. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal care and health care needs are being met by staff who understand their needs and deliver care in a respectful manner. There are satisfactory policies and procedures in place about the administration of medication and peoples privacy and dignity are respected. Evidence: We continued to case track a further two people and looked at their care plans and risk assessments. Information in the AQAA told us that needs and choices are identified during the persons initial assessment and this information is used to draw up an initial care plan. Care plans looked at were person centred, clear and easy to follow, however, they did not tell us whether the person had written these or the level of their involvement. The Assistant Operations Manager confirmed that action is being taken to address this in all of the Trust homes and staff are to receive comprehensive training on personal care plans, initial assessments and record keeping. Care records looked at included, medical histories, appointments with other healthcare professionals, peoples preferences regarding male or female carer and life histories including hobbies and Care Homes for Older People Page 12 of 26 Evidence: present interests. Detailed risk assessments have been written and these showed the action staff should take to minimise the identified risk. Various assessments had been completed on subjects such as, manual handling, pressure risk and nutrition. Daily notes were written and these showed that people were receiving the correct level of care. One care plan looked at showed that consideration had been given regarding the Mental Capacity Act and detailed the action staff must take if a person does not have capacity to make decisions. Two of the three surveys received from people living at the home told us they always received that care and support needed, including the medical support, one usually. Two staff surveys showed they are given up to date information about the people they support, comments written read I am informed by care staff about change in needs or other relevant information along with receiving GP (General Practitioner), district nurses or other healthcare professionals input. Another person felt her knowledge could be improved on some of the life histories and this was discussed with the manager and we were shown my story books which are detailed booklets about peoples life currently being written for people in the dementia unit but will be implemented throughout the home. People spoken to were happy with the level of support given and told us they felt their needs were being met and they are treated with respect. Staff spoken to had a good knowledge of the needs of people who use the service and how to meet them and were observed to be responsive to needs and were respectful and kind. A visiting district nurse told us someone from her team visits the home twice daily to administer insulin injections and at least twice a week to change dressings, she felt people are well cared for, staff carry out any instructions from her and always seek appropriate advice. Information taken from the AQAA told us that policies and procedures concerning the receipt, storage, administration and disposal of medications were available. We looked at medication records of the people whose care was being followed and talked to the member of staff giving medicines at lunchtime. Records showed that the people were receiving their medications correctly, medication was being stored safely and the member of staff confirmed she had undertaken relevant training. The manager told us regular medication audits are carried out and one member of staff has recently completed training on assessing the competencies of staff administering medicines. The homes pharmacist visited the home on 10th March 2009 and their report was looked at, however, no specific comments had been written. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to take part in various recreational activities and maintain contact with family and friends as they wish. Meals provided are well balanced and take into account personal preferences and special dietary requirements. Evidence: Information sent to us prior to the visit indicated that a range of activities were being provided to meet individual needs and an activity co-ordinator works five days each week to ensure everyone has the opportunity to join in if they choose. People who are unable to join in with activities have one to one time with a member of staff or a volunteer and activities offered include a hand massage and manicure. There are regular meetings with people to discuss activities, including community events and these are then posted on display around the home. During the visit people were taking part in a quiz, an exercise class and an art class. People told us they were satisfied with the activities and events offered and showed us their art work, handmade greeting cards, calendar and flower arrangements made for the tables. One person told us he loved to tell a tale and their records showed that a regular volunteer spends time with him each week. Surveys received from people living at the home all identified that activities were available that they could take part in, one comment read Care Homes for Older People Page 14 of 26 Evidence: yes, but I choose not to take part in. People told us they were able to keep in touch with family and friends and have visitors whenever they choose. People told us they are able to have their meals wherever they choose and during the visit we saw people chatting with each other as they ate. All told us they were very happy with the food, menus were varied and a choice offered. Specific comments were the staff make an effort with people who are diabetic and the food is good, if you dont like something they will always make you something else. A survey received prior to our visit from a staff member read menu choices could be improved, more variations and creativity at meal times. This was discussed with the manager who told us this had been raised and menus had recently been re-written offering more choice and variation, she also told us she plans to put menus on individual tables and re-introduce foods specific for people with dementia. We spoke with a senior cook and looked at the proposed menus and these showed a choice of three main courses each day and included a vegetarian option. During our visit people were offered choice and those needing help were given assistance in a sensitive and respectful manner. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the procedures in place for handling complaints and allegations of abuse. Staff have received training in these subjects to help them protect the people they support. Evidence: Information taken from the AQAA tells us there are clear policies and procedures in place regarding complaints and safeguarding adults. The complaints policy is included in the statement of purpose, service user guide and is on display in the reception area of the home together with information about advocacy. This was confirmed during our visit and people told us they feel able to raise issues with their relatives, key worker, care leader or manager and felt these would be taken seriously. The visiting district nurse told us she had never seen anything of concern but felt comfortable to raise any issues should they arise. Surveys received prior to the visit all indicated people know how to make a complaint and who to speak to if they were unhappy. Within the last twelve months one complaint has been made and records for this were looked at. These did not show that a full investigation had been carried out, however, a letter had been sent to the complainant to inform them that the person in question had been spoken to and records evidenced the complainant had signed showing they were satisfied with the outcome. Since our visit we have received information telling us that the complainant had raised the matter as a concern and did not wish for it to be Care Homes for Older People Page 16 of 26 Evidence: escalated into a complaint. However, senior staff are aware that due to the nature of the concern a full investigation should have taken place. One referral had been made to Lincolnshires Safeguarding Adults team and this had been dealt with appropriately and resolved. Training records were held on the computer and the manager looked at these and verified dates staff had undertaken training relating to safeguarding adults. Staff spoken to had a good understanding of the types of abuse and the correct procedures to take to report any incidents. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well-maintained, clean, comfortable and homely environment, which offers a good standard of decor and furnishings. Evidence: We took a partial tour of the home which included looking at the bedrooms of the people whose care was being followed and some communal areas. Bedrooms had been personalised with photographs, mementos and small items of furniture. Bedroom doors are lockable and some people told us they always lock their doors when leaving their rooms and this helped them feel like being at home. There were no unpleasant odours in the home, communal areas were bright and nicely decorated. Specialist equipment is provided such as hoists, moving belts and airflow mattresses and the use of these was detailed in peoples care plans. Information taken from the AQAA told us that within the last twelve months improvements have included; refurbishment to the lounges, some bedrooms and a new summer house has been purchased. The manager told us that their Environmental Health Officer visited on 04th July 2008 and awarded a four star rating and she confirmed that recommendations given had all Care Homes for Older People Page 18 of 26 Evidence: been actioned. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing numbers are in sufficient quantity for them to be able to care for people currently living at the home. The service recognises the importance of training to ensure staff are knowledgeable and equipped to meet the needs of people living here. Evidence: On the day of the visit 36 people were living at the home. Duty rotas were given to us for the past two weeks and showed that there were generally four carers on duty throughout the day time period and one care leader. Throughout the night three carers are on duty. In addition to this there is a registered manager, head of care and administrator on duty. During our visit the training manager for the Trust was on the premises to carry out an audit of training. Three surveys received prior to our visit from people living at the home told us staff were always or usually available when needed and people spoken to during our visit said they felt there were enough staff on duty and told us the staff are wonderful and the girls are so kind. Surveys received from staff both identified there were usually enough staff on duty to meet individual needs although, comments read due to a member of staff leaving we are running a little bit short staffed until the post can be filled, and, individual needs vary from day to day, some days needs may exceed and staff can be slightly overwhelmed, but on other days the individual needs are met Care Homes for Older People Page 20 of 26 Evidence: completely. Staff spoken to during the visit confirmed this but felt they generally had enough time to complete their tasks without rushing and observation of care practises during the visit showed staff caring for people in an appropriate manner. They were visible in communal areas and responded well to peoples needs. The records of two staff recently employed were looked at and these showed that essential checks such as written references and C.R.B. (Criminal Records Bureau) checks were being undertaken and records showed both had received induction training which meets current standards. Information received prior to the visit told us that over 50 of staff have achieved a nationally recognised vocational award in care. The training manager told us that this has now exceeded 60 and he is currently looking at extending the training opportunities of all non-care staff including the maintenance person. One member of staff has been appointed as dementia champion and has completed relevant training to achieve this. Prior to our visit we received two surveys from staff and these told us their induction training covered everything they needed to know to do the job and they receive ongoing training relevant to their role and staff spoken to said they felt well trained and supported. The Organisation have a good training programme covering a variety of topics and some training is completed using E-learning. Training records confirmed that staff had received essential training to meet the needs of the people they support. Training undertaken included, manual handling, first-aid, fire awareness, dementia awareness, health and safety and safeguarding adults. Awareness of the Mental Capacity Act training had been provided in small groups using a computer and the training plan showed that further training is scheduled for July of this year. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home is well managed and the staff are supported and supervised in carrying out their roles. The audit and policy systems ensure that peoples views are listened to and acted upon. Evidence: The manager is suitably qualified and experienced to run this home. She has recently moved from another of the Trust homes where she had been the registered manager for a number of years and is currently in the process of registering to manage The Poplars. Surveys received prior to the visit raised no concerns regarding the current management arrangements and people told us they feel the manager is approachable and very supportive. People living in the home spoke highly of the manager and all felt the home was well run. Discussion and records showed that there are various systems in place to monitor the quality of the service being provided. This includes seeking the views of people through meetings and questionnaires, the results of surveys are collated and an action plan is written detailing the timescale for any issues to be Care Homes for Older People Page 22 of 26 Evidence: addressed. Records of visits made by the organisation showed us that a representative visits the home at least once a month and completes a report on their findings to evaluate how the home is operating. Information provided in the AQAA told us that there are a range of policies and procedures in place and the majority of these had been reviewed and updated in 2008. We were also told of equipment maintenance and service dates. Building risk assessments are in place and regular health and safety audits are completed. The Department of Health Essential steps is used to assess infection control and records showed staff receive health and safety training. Personal finances for the people whose care was being followed were checked and records maintained were up to date and accurate. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Care plans should show whether the person had written these or the level of their involvement. Care Homes for Older People Page 25 of 26 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. 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