Care Home: The Rookery

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What the care home does well The Rookery provides respite care in a family home environment. People who use this service are welcomed and made to feel `at home`. They are treated with dignity and respect and are encouraged to make choices about their daily life. The quality of care is good, with people receiving very individual care and attention. Arrangements for health care services are good and the provider works closely with the local district nursing service to ensure people get the care and treatment they need. Medicines are handled safely with most people managing their own medicines, as they would at home. There are plenty of opportunities for outings into the community, with regular lunches out, attendance at local coffee mornings and shopping trips or car rides. Activities are planned according to peoples` wishes at the time. There are regular lunch gatherings at The Rookery, with friends and neighbours, which some people choose to attend between their respite stays, to keep in touch. People are able to take part in light household chores if they wish to, to maintain their skills and independence. The home is comfortable and well maintained. People are able to bring some personal possessions and equipment with them, and most have a preferred bedroom they stay in. The home is clean and fresh, and the provider has a good understanding of hygiene and infection control. People were very positive about the service, saying they were very happy here, felt valued and enjoyed their stays. One person said staying at The Rookery `enriched` her relatives life. What has improved since the last inspection? Since the last inspection the provider had updated the contract of residency for people, so this now states what the fees cover and what is charged for as extra. The complaint procedure had been updated with new contact information. Admission assessments for people receiving regular respite care were now being updated prior to each visit. The bathroom had been decorated, and the shower had new parts fitted. The porch windows had been replaced. The damaged stair carpet had been repaired. Smoke detectors had been installed and an emergency light fitted in the stairway. The stair lift and bath seat had been serviced. An external company had conducted a fire risk assessment of the premises and now maintained the fire alarms and equipment. The provider did weekly fire alarm tests and had conducted some fire drills. Moving and handling training had been undertaken, and the provider had started a distance learning dementia course. What the care home could do better: The Statement of Purpose does not make clear that The Rookery no longer provides permanent care and accommodation for people. This should be updated so people know the service offers only short term respite stays. The provider should keep copies of any staff training certificates on file to evidence what training had been completed. Key inspection report Care homes for older people Name: Address: The Rookery Milnthorpe Road Holme Carnforth Lancashire LA6 1PX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jenny Donnelly     Date: 2 9 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 26 Information about the care home Name of care home: Address: The Rookery Milnthorpe Road Holme Carnforth Lancashire LA6 1PX 01524782304 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Rose Ann Savage care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 3. Date of last inspection Brief description of the care home The Rookery provides respite care and accommodation for up to three older people. The home is a two-storey house situated in a quiet location on the outskirts of the village of Holme near Carnforth. The detached property is set in pleasant grounds with a small parking area to the front of the home and accessed by a short driveway. The home is within walking distance of the village where there is a post office, public house, churches and other amenities. There is a bus stop at the end of the driveway for the bus service to Kendal, Lancaster and points in between and beyond. The home has a large lounge, kitchen/diner, a further, small lounge, a downstairs toilet and one Care Homes for Older People Page 4 of 26 Over 65 3 0 1 2 0 3 2 0 0 9 Brief description of the care home ground floor bedroom. A stair lift allows for easy access to the first floor where there are two bedrooms for residents, one of which has en-suite facilities. There is a separate bathroom with bath and shower. The proprietor also has accommodation on the first floor. Copies of inspection reports, service user guides and the homes statement of purpose are available from Mrs Savage, the owner and manager of this service. The weekly fees at the time of this insepction were £398.00. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was the main or key inspection for the year. The lead inspector Jenny Donnelly asked the registered provider to fill out a form called the Annual Quality Assurance Audit (the AQAA). This asks for details of what has improved in the home since the last inspection and for the plans for the coming year. This was fully completed with a good amount of detail and returned to us shortly after the date we asked. We also sent surveys for people who use the service, and their relatives. The provider passed these onto the people who receive regular respite care at The Rookery, and they were completed and returned to us. We arranged for our inspection visit to take place when people were booked in for respite care, as the home is not always occupied. Jenny Donnelly made a visit to the care home on 29th January between the hours of 10 am and 2 pm. During this visit we (the Care Quality Commission) toured the Care Homes for Older People Page 6 of 26 building, spent time with people in the lounge, and joined them for lunch in the kitchen. We spoke with people staying in the care home, their visitors and with the district nurse. We also spoke with the provider and looked at files and documents that backed up what we were told and what we saw. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: The Statement of Purpose does not make clear that The Rookery no longer provides permanent care and accommodation for people. This should be updated so people know the service offers only short term respite stays. The provider should keep copies of any staff training certificates on file to evidence what training had been completed. Care Homes for Older People Page 8 of 26 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 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 10 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. The admission process for new people, and for those receiving regular respite care, was thorough. This helps to identify any changes in peoples needs, and helps them to settle into the home quickly when they arrive. Evidence: There was an information pack available about the services and facilities offered at The Rookery. This was useful and informative, but did not clearly show The Rookery only offers short respite stays, and not permanent care. This should be updated so people are clear about the services being offered. Further to last inspection, the terms and conditions (contract) of stay had been updated to provide information about what the weekly fees cover, and what is charged for as extra. We saw that people had a copy of this updated contract on file. People new to the service, had an assessment of their needs completed before they Care Homes for Older People Page 11 of 26 Evidence: were offered respite care at The Rookery. The assessment included gathering information from the persons family, their social worker if relevant, and in a face to face meeting with them. New people were invited to visit the home and stay for lunch, before choosing to make a booking for respite care. They could also choose which bedroom they preferred. This assessment process helped the registered provider, and the person, know if the home would be suitable for them. We spoke with a visitor who said her relative had been for lunch a couple of times, and met with other people using the home, before she came for her first stay, and this had helped tremendously. There were a small number of people who received regular respite care at The Rookery throughout the year. Further to a recommendation made at the last inspection, the provider was now updating peoples assessments prior to each visit. This helps her to be aware of any changes in their care needs. This was done over the telephone with the persons family or social worker prior to the planned respite, and again through a sit down chat on the day of their arrival. One person told us; The Rookery is small, very welcoming, friendly, considerate and helpful. It is home from home, not like an institution where you are treated less personally. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive very individually tailored care and support, delivered in a way that is acceptable to them, and promotes their privacy, dignity and general well being. Evidence: We looked at a sample of the care records for people who come to stay at The Rookery. Each had a plan of care to show the level of support they needed, and this included information about their individual wishes and choices. There were risk assessments in place for peoples moving and handling needs, and good information about any ongoing health requirements. There was information on any special dietary needs and preferences, and peoples weight was monitored during their stay. The district nurse visited while we were in the home, and told us the registered provider communicated well with her and followed any advice she gave. The registered provider was happy to take people along for any routine health appointments that fell during their stay at The Rookery. There were also good systems in place to call on local health services in the case of any emergency. A physiotherapist had visited the previous day to see one of the people staying in the Care Homes for Older People Page 13 of 26 Evidence: home. People told us they were very happy with the care and attention they received at the Rookery, saying; I was feeling a bit down, but I am feeling much better after a week here. I have eaten well and have put some weight on. My walking is also getting better. We are well looked after, I have my bath, and she (the other person in residence) has her shower, when we want. A relatives survey told us; The Rookery values people and respects their individuality. Listens and responds accordingly. Is flexible and orchestrates routines and events around individuals preferences. Ensures that opinions are sought and that these are respected. Provides a positive, welcoming atmosphere which is consistently cheerful and responsive. We spoke with a visitor who talked about how staying at the home had enriched her relatives life. We looked at the handling of medicines and saw these were being safely managed. The provider encouraged people to manage their own medicines, as they did at home, and she discreetly monitored and supported people to make sure they were safe. Medicines were securely stored and clearly labelled. Medication administration record charts were maintained, and these were completed accurately. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This small care home provides individually tailored activities and occupation, and enables people to engage in a full and meaningful social life if they want to. Evidence: People who stay at The Rookery are encouraged to continue with their normal daily routines as they wish. Activities are very person centred and based on what people choose to do each day. The provider knows some people like to go out shopping a lot, where as others prefer to stay in, and she is able to accommodate this. People, if they are able and want to, can assist with the daily routines of running the home, by setting and clearing tables, and doing other small jobs. This gives people some purposeful occupation and helps them maintain their independence for when they go home. One person told us they had enjoyed a trip into the local town the previous day, and liked to attend coffee mornings. Another person told us they were all going out for Sunday lunch. The provider said a neighbour sometimes joined them for lunch, and had become a friend to the people who stay at The Rookery. One person who comes for regular respite, told us she attends these weekly lunch gatherings when she is living at home, and likes having this regular contact. Care Homes for Older People Page 15 of 26 Evidence: Food is freshly prepared each day, and menu planning is done jointly, with people discussing and choosing what they would like. The provider was aware of peoples preferences and catered accordingly. Meals are taken at the table in the family kitchen and were a social event. Evenings were spent together, watching television or chatting about the day and their plans for tomorrow. The provider said no one chose to sit alone in their room, and people who came for regular respite enjoyed having contact with her family when they visited. People told us; My relative stays at The Rookery several times a year and is always happy to go along for her holidays and we have peace of mind knowing this. Her personal care is excellent and she especially enjoys the independence of walking outside. I have been coming to The Rookery for 7 or 8 years and I enjoy it. There is always some one to talk to. Some times we go out for a ride and have a meal out. Care Homes for Older People Page 16 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 who stay at The Rookery felt confident that they could raise any concerns with the provider, and felt safe and secure in the home. Evidence: There was a complaints procedure that told people what to do if they were not happy with the service provided at The Rookery. The provider told us she had never received a complaint, and non have been made to the commission. People we spoke with, and those who completed our surveys told us they would speak with the provider if they had any concern, but did not think this likely. The home had received lots of cards and letters of thanks and praise. The provider and her one part time staff member had completed a distance learning course on safeguarding vulnerable adults last year. They also had a copy of the Cumbria multi-agency guidance on safeguarding, and the provider was aware of the local referral procedures. There had been no referrals. People on the day told us they were very happy at The Rookery, felt safe and had no concerns. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Rookery provides a comfortable family style, clean, safe environment, and has adaptations to assist people to access the stairs and bath. Evidence: The Rookery is a family style home with one ground floor and two first floor bedrooms, one of which has an en suite bathroom. There is a kitchen / diner, and a large lounge for people to use. There is a toilet downstairs and a family bathroom upstairs with toilet, a bath with seat and a separate shower cubicle. The property is detached with a large a garden surrounding it. There was good access and car parking space at the front of the building. The home was well maintained, warm, comfortable and nicely decorated throughout. People were able to bring personal possessions with them to make their bedroom homely, and the provider said one person brought her own special mattress. There were grab rails in the toilet and there was a stair lift to help people with mobility problems. People brought their own personal aids such as zimmer frames and walking sticks. We saw the maintenance plan which showed that since the last inspection, the bathroom had been decorated, parts of the shower had been replaced, and there were two new windows in the porch. The provider was now in the process of replacing part of the laundry floor, where there were some cracked tiles. We saw that the damaged stair carpet seen last time had been repaired and made safe. Care Homes for Older People Page 18 of 26 Evidence: We saw service records that showed both the stair lift and bath seat had been checked and serviced by a qualified electrician to ensure they were in safe working order. The home was clean and fresh and the laundry was well managed to reduce any risk of infection. There were hand washing facilities and alcohol hand gels for staff and visitors to use. Protective clothing such as gloves and aprons were available if needed. The provider had information from the Health Protection Agency on infection control in care homes. People told us they were very comfortable and were able to book their favourite bedroom when they came to stay. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are individually supported by the provider and one other staff member who they know well. Both are very experienced and undertake periodic training to update their skills and knowledge. Evidence: There is just one member of staff employed in addition to the registered provider. This person is employed on an occasional basis according to the number and care needs of people accommodated. This person has been employed by The Rookery for some time and we have previously checked their recruitment records, and found the process was thorough and included all necessary checks. Both the provider and the staff member completed training in safeguarding vulnerable adults last year. The provider has also undertaken a safe moving and handling update with the district nurse, and has embarked on a distance learning dementia training course. The member of staff undertakes the majority of her training with her main employer, also a care provider, but The Rookery did not have copies of her certificates to evidence this, and we recommend they do so. We saw that both the provider and staff member had completed fire drills. People told us they knew the provider and staff member well, and had trust and confidence in them. The district nurse confirmed the provider had a good relationship Care Homes for Older People Page 20 of 26 Evidence: with the district nursing team and asked for information and advice when necessary. 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. The Rookery was safely managed, to promote and protect the safety and well being of people who use the service, and to take into account their views and wishes. Evidence: The Rookery is owned and managed by the registered provider, Mrs Savage. She is skilled and knowledgeable about the needs of the people who use this service regularly. Mrs Savage carries out some quality monitoring, and asks people to complete post stay surveys. We saw some of these on file along with letters and cards of thanks and praise for her care and attention. The people we spoke with, and those who completed our surveys expressed complete satisfaction with the care and services offered at The Rookery. People were encouraged to maintain responsibility for their own finances during their stay, and there was safe storage available for valuables if needed. The staff member Care Homes for Older People Page 22 of 26 Evidence: received supervision suitable to her role and there were records of this. Since the last inspection improvements had been made to maintaining general health and safety in the home. The damaged stair carpet had been repaired and the bath seat and stair lift had been serviced. A fire risk assessment had been completed by an external company, and they continued to check and maintain the fire safety equipment in the home. There were new smoke detectors, and an emergency light had been fitted in the stairway. The provider was now doing weekly fire alarm checks and there was a record of alarm activations and fire drills. We saw other safety records including a gas safety certificate and safety testing of electrical appliances. There was an accident record book for recording and reporting any accidents or injuries that occurred. 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 1 We recommend the Statement of Purpose be updated to reflect that the home only provides respite, and not permanent care. We recommend that staff training records and certificates are kept to demonstrate what training has been undertaken. 2 30 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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