Care Home: The Seymour

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What the care home does well They ensured that people`s needs and wishes were fully assessed before they moved into the Seymour. This helped ensure that the home had the facilities to meet the individuals` needs. Systems were in place to help ensure that people received the medical support they required at all times. Activities were available for people to participate in at the home and within the local community. People were supported by a staff team who knew them well and who received training for their role. People were confident in the homes complaints procedure and knew who to talk to if there were not happy. They provide a comfortable environment for people to live. What has improved since the last inspection? They are now maintaining detailed records of medication that has been delivered, administered and returned to the pharmacy. Regular audits of medication now take place on a weekly basis and prescribed creams were stored appropriately. Improvements had been made to the cleanliness of the kitchen. What the care home could do better: They must ensure that the medication policy includes information about medication that is prescribed on an as and when basis. Information about when to administer PRN medication must be available for each person prescribed this type of medication. A lockable storage facility must be available for all medication requiring refrigeration. These improvements will help ensure that people`s medication is stored and administered correctly. Key inspection report Care homes for older people Name: Address: The Seymour The Seymour 327 North Road Clayton Manchester M11 4NY     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: Adele Berriman     Date: 2 7 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 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 28 Information about the care home Name of care home: Address: The Seymour The Seymour 327 North Road Clayton Manchester M11 4NY 01612208688 01612314306 ashvanipatel@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Seymour Home Limited care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies of service only: Care home only- Code PC To people 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 (18) Dementia- Code DE (8) The maximum number of people who can be accommodated is: 26 Date of last inspection Brief description of the care home The Seymour is a privately owned residential home providing personal care for up to 26 older people. The home is located in Clayton, north of Manchester City Centre and is close to public transport links into Manchester, Oldham, Droylsden and Ashton. Bedroom accommodation is provided on the ground and first floors accessed via a passenger lift. Sufficient toilet and bathing facilities were provided within close proximity to bedrooms and communal areas. Accommodation is provided in 18 single rooms and 4 double rooms. Three of the single rooms were fitted with en-suite Care Homes for Older People Page 4 of 28 Over 65 0 18 8 0 Brief description of the care home facilities. Wheelchair access is provided and there is parking space to the front of the building. There is a large rear garden that is pleasant for residents who are able to sit out in the warmer weather. The current range of accommodation fees are between 398 and 450 pounds per week. Those items not included in the fees are: Newspapers, hairdressing, private treatments, some transport costs and some entertainment costs (such as trips to theatres etc). A full range of `extras charged for are included in the `Terms and Conditions of Residence provided to all residents on admission. 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: We carried out an unannounced visit to the home on the 27th August 2009. The visit began at 10.40am and ended at 7.00pm. The visit formed part of a key inspection of the home in which all of the key standards were assessed. During our visit we spent time talking to people living at the Seymour, two members of staff, the registered manager and the deputy manager. We looked at all the communal living areas and a selection of bedrooms and bathrooms. We looked at a selection of records, policies and procedures during the visit, these included care plans, staff files, medication records and daily records. Before we visited, one member of staff completed a survey form to tell us their thoughts on working at the Seymour. Care Homes for Older People Page 6 of 28 Prior to our visit the manager of the service completed an Annual Quality Assurance Assessment (AQAA). This document gave them the opportunity to tell us what they thought they did well, what they thought they could do better and what improvements they had made over the past 12 months. The AQAA was well written and also contained some numerical information we asked for. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. 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 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 9 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 their needs assessed before they move into the home to ensure that their needs can be met. Evidence: We saw that a pre admission assessment was carried out prior to a person moving into the The Seymour. The purpose of this assessment was to ensure that the staff were aware of peoples individual needs and to ensure that the home had the facilities to meet these needs. We saw that information gained during the pre admission assessment process was recorded on a set format. The document gave the opportunity to record peoples care and health needs within their day to day life. When required an assessment for memory services was also completed. We saw completed pre admission assessments on peoples care plan files. Care Homes for Older People Page 10 of 28 Evidence: People were invited to visit the home for the day, have a meal and when possible for an overnight stay prior to making a decision about moving into The Seymour. They told us that information gained during the assessment was also used as a draft care plan for when the person initially moved in the home. We spoke to a visiting relative during our visit. The told us that they had been given good information about the service before their relative moved in. We saw that they had recently updated their information pack about the home. The pack was informative and told people about the homes statement of purpose, information about the living environment, the management and staff qualifications, policies, procedures and information about the extra costs for activities, planned hospital appointments and other services within the home. The Seymour does not provide intermediate care facilities. Care Homes for Older People Page 11 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. The promotion of peoples health is taken seriously and peoples welfare is monitored and health needs are met. Evidence: We saw that each person had their own file that contained their personal information, pre admission information and their care plan. We looked at three peoples care plans. We saw that care plans contained information about peoples day to day needs and wishes. The member of staff who completed a survey form told us that they always were given up to date information about the needs of the people they care for. We saw that care plans identified peoples needs, however, not all of the information gave clear instructions on how the need should be met by the staff team. For example, care plans contained instructions including carers to assist and guidance. To help ensure that people receive consistent support, information should be available to states how staff are to assist and what guidance is required. Care Homes for Older People Page 12 of 28 Evidence: Daily records were maintained and updated throughout the day. We saw that the records contained information about personal care and support and the persons dietary intake. We saw that risk assessments specific to individuals needs formed part of peoples care plans. We saw risk assessments that considered the use of bed rails, moving and handling, nutrition, pressure areas and the environment. We saw that the format for assessing and recording known risks recorded situations as low, medium or high. We saw no information that showed us how the risk had been calculated. A key to the risk assessments in use should be available to demonstrate what actions are needed to minimise the identified risk for people. None of the care plans that we looked at contained information relating to peoples capacity to make decisions. Where necessary, care plans should contain information about individuals capacity to make decisions under the Mental Capacity Act 2005 framework. We saw records that demonstrated that people had regular access to local health care professionals. People told us that if they requested a GP the manager would arrange for a visit. All three people told us that their health care needs were met at the home. They told us that a psychiatrist visits the home every three months for a surgery and to support with training for staff. The psychiatrist also arranges for Community Psychiatric Nurses to visit and address any concerns that the service may have about a persons mental health needs. Throughout our visit we observed people being treated in a friendly dignified manner by the staff team. We spoke to a visiting health care professional. They told us that they visited several people at The Seymour. They told us positive things about the home. They told us that they thought the care was pretty good and that they thought that the staff were resourceful. We saw that they had policy for recording, receipt, administration and disposal of medication. The policy did not contain information about the administration of medication prescribed on an as and when required basis (PRN). We saw that several people who were unable to decision about their medication had been prescribed PRN medication. Detailed information should be available from the prescriber regarding Care Homes for Older People Page 13 of 28 Evidence: when PRN medication should be offered and administered. This will help ensure that people receive their medication when they need it. We saw the majority of medication was stored in locked trolleys and cupboards in a secure room. Medication requiring refrigeration was stored in a fridge that was not secure. A lockable facility must be made available for all medication requiring refrigeration to ensure that it is securely stored. 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 are involved in a good range of activities both in the home and in the community which provides an interest for people in their day to day life. Evidence: We saw that activities took place daily with a member of staff having the role of activities co ordinator during the afternoons. On the day that we visited we saw people listening and dancing to music from the past. Activities available included keep fit with balls and music, bingo, music, times gone by and reading. They told us in their AQAA that over the next 12 months they intend to consult with a dementia therapist for assistance with the development of multi sensory room within the home. People from the local church support people to a weekly coffee morning at the church. Two people visited the local bowling green once a fortnight and an outside performer visited once a month. They told us that people are invited to a local garden party twice a year and that they have annual trips to Blackpool and Chester zoo. Care Homes for Older People Page 15 of 28 Evidence: We saw that people had the opportunity to continue with their religious preferences, for example, a service with communion was conducted by a representative of the Church of England on a regular basis. A Roman Catholic priest also visits on a weekly basis to meet with people for communion. They told us that many people were still in touch with their families and that visitors were encouraged to visit at any time. We spoke to a visiting relative who told us that they visited on a daily basis and were always made welcome. We saw a sample of the food menu. It demonstrated that people were given a choice of two meals at lunch and tea time. We saw that only one option of meal was available for people who required a soft or blended diet. A choice of meal should be available to all at mealtimes. We saw that the menu was in written form. The introduction of other means for people to choose their food should be considered to help orientate people at meal times, for example, a pictorial menu. We saw that meals were served in one of two dining areas on the ground floor of the home. We saw that tables were set with cutlery, cups, saucers and condiments. One person told us that the food was OK and another person told us that it was generally nice. We saw that one person did not eat their hot meal. They told us that this was because they did not like gravy. We saw that a choice of what people wanted to eat was not always given when the food was being served. To help ensure that people receive the diet they require peoples choices and preferences should be considered when meals are being served. 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. People using the service were protected by the complaints and safeguarding procedures available. Evidence: We saw that information relating to the homes complaints procedure was available. The told us that since we last visited they had reviewed their complaints procedure and had now produced it in large print to help people read it easily. A register was available for the service to record any complaints that had been made. They told us that they had received five complaints within the last 12 months, none of which had been upheld and all had been responded to with 28 days. People who we spoke to during our visit knew who to speak to if they were not happy and were confident that any complaints would be addressed by the manager. We saw that they had policies and procedures in place for the protection of vulnerable people. A copy of Manchester City Councils safeguarding procedures was also available. During our visit the manager demonstrated a good awareness of the local authority safeguarding procedures. No safeguarding referrals had been made regarding service within the last 12 months. Care Homes for Older People Page 17 of 28 Evidence: We saw training records that demonstrated that staff had received training for the safeguarding of vulnerable people in April 2009. 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. A clean, comfortable environment was provided for people to live in. Evidence: The Seymour is situated on a main road close to public bus services. A large garden was available to the rear of the home. They told us that they intended to plant shrubs, flowers and plants around the garden to encourage people to spend more time outdoors. They had a programme on ongoing maintenance and refurbishment. They told us that when a bedroom becomes vacant they decorate the room. They told us that they had consulted with people and their families to gain their views on their decor preferences for bedrooms and communal areas. We spoke to a visiting relative who told us that they were fully aware of the refurbishment plans for the home. A handy person was employed at the home for 16hrs per week for general maintenance and repairs. This included the regular testing of the fire detection system. We looked at the dining rooms, lounges and several bathrooms that were for communal use. We saw that they were clean and tidy and contained furniture and equipment to meet peoples needs. Care Homes for Older People Page 19 of 28 Evidence: We looked at several bedrooms and saw that they had been personalised with peoples personal effects. One person who showed us their bedroom said that they liked it very much. 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 well trained, effective staff team who know them well. Evidence: We saw that three carers, the deputy manager, a cook and a domestic member of staff were on duty to meet the needs of the 26 people in residence. The registered manager was also on duty. People told us good things about the staff team, comments included Im very happy with the staff and the staff are very good. We observed staff supporting people in a caring and supportive manner. The staff team demonstrated a good awareness of peoples needs. We looked at the files of three people, two of which had been recruited since we last visited. We saw that the majority of files contained the information required. We saw written references, application forms, records of interviews and evidence that Criminal Record Bureau disclosures had been applied for. We saw on two application forms that all of the information had not been completed. To help ensure that only people suitable for the role are employed, application forms should contain a detailed history of previous employment. Care Homes for Older People Page 21 of 28 Evidence: We looked at staff training information and saw that staff were receiving training relevant to their role. We saw that all staff had received training in safeguarding vulnerable adults and fire awareness. We saw that the majority of staff had received awareness training on dementia, food hygiene, infection control,person centered care, nutrition and wellbeing, the safe handling of medication and recording with care. Some staff had also received training on equality and diversity, first aid, the Mental Capacity Act and personal safety and interactive communication. The member of staff who completed a survey form told us that they were being given training that was relevant to their role, that helps them understand and meet the needs of people and that keeps them up to date with new ways of working. They told us that their manager regularly gives them enough support and meets with them to discuss how they are working. They told us that all staff had achieved a National Vocational Qualification (NVQ) level 2 and that 10 staff had achieved or were working towards their level 3. Having appropriately trained staff available helps ensure that people receive the care and support they require. 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 Seymour is being run in the best interests of the people who live there and their welfare is protected. Evidence: The registered manager had many years experience in working in social care environment and held the required qualifications to carry out her role. During our visits the manager demonstrated a good awareness of peoples needs and what actions were needed to further improve the service. The service has the Investors in People award and the manager had the Dignity in Care award. They told us that they held regular meetings with people, their families and staff to discuss issues relating to the management and development of the service. They told us that they carry out an annual survey with people, their families and Care Homes for Older People Page 23 of 28 Evidence: visiting healthcare professionals. The purpose of the survey was to gain peoples views on the service and identify areas of improvement. They told us that the surveys had recently been sent out and once they had been returned, the provider and the manager would create an action plan and feedback to people the results of the survey. Procedures were in place to safeguard peoples financial interests. We saw that details of the procedures were available in the service users guide that people receive when they move into the home. We saw that accidents were being recorded, that records were stored appropriately and the manager had a system in place for monitoring accidents on a monthly basis. We looked at the records and found that not all accidents had been reported to the Commission. To help ensure that the home tells us information that we need to know, all incidents and accidents resulting in a person being taken to hospital must be reported to the Commission. We saw that policies and procedures were available to support the health, safety and wellbeing of people. Care Homes for Older People Page 24 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 25 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 9 13 The medication policy must include information about the use of medication prescribed on an as and when basis (PRN). Information relating to when PRN medication is administered must be available for people who do not have the capacity to request it. Secure storage must be available for medication requiring refrigeration. This will help ensure that people receive their medication appropriately. 10/11/2009 2 31 37 All incidents and accidents 11/11/2009 within the home must be reported to the Commission. Care Homes for Older People Page 26 of 28 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 This is to ensure that the manager tells the Commission about things we need to know. 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 clearly demonstrate what actual assistance and guidance is required by staff to support people with their care. A key to peoples individual risk assessments should be available to demonstrate how low, medium and high risks have been calculated. They should also fully demonstrate what actions need to be taken to minimise the risk. Care plans should include information that considers peoples capacity as outlined in the Mental Capacity Act 2005 framework. 2 15 To help ensure that people receive the diet they require a choice of what foods they wish to eat should be given when the meal is being served. The service should consider using a pictorial menu to help people who are unable to read the menu to choose what they want to eat. 3 29 Staff application forms should be completed in full and contain fully dates and details of previous employment and work experience. All staff files should contain all information listed in Schedule 2 of the Care Homes Regulations 2001. Care Homes for Older People Page 27 of 28 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). 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