Care Home: The Yews

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What the care home does well Staff told us that because The Yews is a small home they are familiar with people`s needs and preferences. Staff told us that the manager was very supportive to the staff team and actively involved in the running of the home. The home has a whippet which the residents were seen fussing and enjoying. Some people also had budgerigars in their bedrooms. Care plans seen covered areas such as communication, eating and drinking, personal care, mobility, health and continence. They contained some detail about people`s preferences such as their preferred name and what time they liked to get up and go to bed . Care plans contained details of how to support and care for people with dementia related needs. For example advising staff to offer reassurance to people if they are anxious. The manager explained that people are able to use the computer in the dining room if they wish to and a large keyboard has been purchased to make it easier for people to use. The manager told us that people liked looking at photographs on the computer. One person told us that, "the food is always good." The menu was seen and looked varied and nutritious. The home is clean, well maintained and comfortable and provides people with homely living accommodation. What has improved since the last inspection? People who live at the home have access to a computer with internet access. What the care home could do better: The home needs to ensure that all medication can be stored safely and in line with the latest requirements of the Misuse of Drugs Act Amendment 2007. Where people have been identified as being at risk of developing pressure sores, their care plan must clearly state what the home is doing to care for the person in a way that reduces that risk. Care plans should be updated to reflect the current advice of visiting health professionals. Records should clearly detail how a person`s capacity to consent to specific decisions has been assessed. Where someone is deemed not to have the capacity to make a decision, how any course of action has been assessed as being in their best interests should also be recorded.None of the windows on the first floor had opening restrictors and there was no evidence that the risk of someone falling out of the window had been formally assessed. The home should ensure that where someone has given a relative or representative "power of attorney" it is clearly documented whether this relates to financial decisions, health and welfare decisions or both and whether any restrictions have been placed on the powers given. Key inspection report Care homes for older people Name: Address: The Yews 73 Kettering Road Burton Latimer Northants NN15 5LP     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: Catherine Perrins     Date: 0 6 1 1 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 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 Yews 73 Kettering Road Burton Latimer Northants NN15 5LP 01536722561 01536505483 georgekhaw@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr George Peng Khye Khaw,Miss Elizabeth F David care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: No person falling within the category DE(E) can be admitted where there are 6 persons in the category DE(E) already in the home. The Home will limit its services to the following service user categories: No person falling within the category Older Persons (OP) can be admitted where there are already 13 persons of category OP already in the home. The total number of service users in the Home must not exceed 13. Date of last inspection Brief description of the care home The Yews is a privately owned care home providing personal care only for older people. It is registered to admit up to 13 people within the category of old age, within this total, up to 6 persons within the category of dementia (DE (E)) can be admitted. All persons admitted to the home are over the age of 65 years. One of the jointly registered owners, Mr Khaw, is also the registered manager and is responsible for the Care Homes for Older People Page 4 of 26 Over 65 6 13 0 0 Brief description of the care home day to day running of the home. Bedrooms are situated on two floors. A stair lift provides access to the first floor. Communal areas include a dining room and lounge. All communal areas are located on the ground floor. There is a large garden to the rear of the home which people can access if they wish to. The managers office is located in a small building sited in the rear garden. Both the registered persons live within the grounds of the home. The current fees range from 381 to 465 pounds per week. 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: The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection which means that we focused on the key national standards. The key standards are those considered by the Commission to have the most impact on outcomes for people who use the service. As part of the preparation for this inspection a period of four hours was spent reviewing the information that CQC has about this service. We looked at all the information that we have received, or asked for, since the last key inspection. This included: The annual quality assurance assessment (AQAA) that was sent to us by the service. Care Homes for Older People Page 6 of 26 The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Surveys returned to us by people using the service and from other people with an interest in the service. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. Relevant information from other organisations. The inspection was conducted over two days with four hours being spent in the home during a morning and afternoon of the first day and and a further two hours being spent on the second day. During the inspection three people were case tracked. This involves looking in detail at all aspects of their care and experiences at The Yews, including looking as their individual plans of care and other records, talking to them and talking to their care staff. Because people with dementia are not always able to tell us about their experiences we also used observations of peoples state of well being and how they interacted with staff members and others. A sample of staff files were also viewed as part of the inspection. The registered manager was not present on the first day of inspection but was for the for the second day. 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 home needs to ensure that all medication can be stored safely and in line with the latest requirements of the Misuse of Drugs Act Amendment 2007. Where people have been identified as being at risk of developing pressure sores, their care plan must clearly state what the home is doing to care for the person in a way that reduces that risk. Care plans should be updated to reflect the current advice of visiting health professionals. Records should clearly detail how a persons capacity to consent to specific decisions has been assessed. Where someone is deemed not to have the capacity to make a decision, how any course of action has been assessed as being in their best interests should also be recorded. Care Homes for Older People Page 8 of 26 None of the windows on the first floor had opening restrictors and there was no evidence that the risk of someone falling out of the window had been formally assessed. The home should ensure that where someone has given a relative or representative power of attorney it is clearly documented whether this relates to financial decisions, health and welfare decisions or both and whether any restrictions have been placed on the powers given. 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. People are given good information about the home and their needs are fully assessed before they move in to ensure that the home is right for them. Evidence: The home has a combined statement of purpose and service user guide which give people good information about the home and the services it offers. The manager explained that the statement of purpose / service user guide are available in large print on request to make it easier for older people to read. The manager also told us that there is a programme on the computer in the homes dining room that can read the statement of purpose / service user guide to anyone who would like to listen to the information in an audio format. Records show that peoples needs are assessed before they move to make sure that the home is right for them. Care Homes for Older People Page 11 of 26 Evidence: People told us that they were able to visit the home before they moved in to help them decide if it is the right move for them. Where people are not able to visit, their relatives or friends can do so on their behalf. 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. Peoples personal care and health care needs are being met by staff who understand their needs and deliver care in a respectful manner. Evidence: Each person who lives at the home has an individual plan of care. This contains their care plans and other information that staff need to care for people in the right way. Care plans seen covered areas such as communication, eating and drinking, personal care, mobility, health and continence. They contained some detail about peoples preferences such as their preferred name and what time they liked to get up and go to bed for example it was noted that one person likes to go to bed at 7:30 but will tell staff if she would like to stay up later Records show that people had been assessed to find out if they are at risk of developing pressure sores. One person who had previously had a pressure sore did not have a pressure care plan in their file. Records show that the sore she had healed and staff confirmed this to be the case and detailed how she was supported to Care Homes for Older People Page 13 of 26 Evidence: minimise the risk of developing further sores. Care plans contained details of how to support and care for people with dementia related needs. For example advising staff to offer reassurance to people if they are anxious. Recognised assessments and screening tools are used to assess people for the risk of falls, moving and handling and nutrition. There was evidence that people have access to a range of health professionals such as general practitioners, specialist nurses, podiatrists, opticians and dentists. One person had been advised by a medical professional that they needed a high fibre diet. Staff were able to detail how they ensure that this persons diet is high in fibre but this information was not recorded in their care plan. People had a recording sheet in their individual plan of care that stated whether or not they had consented to having a flu vaccination but, it was not clear from this sheet, how their consent had been assessed. The administration of medication is generally well managed with all entries on the medication record being signed to show that people are receiving their medication as prescribed. The storage of medication needs to be reviewed to ensure that the home is able to store any controlled drugs safely and to ensure compliance with the latest requirements of the Misuse of Drugs Act Amendment 2007. This specifies how care homes should store controlled drugs. Controlled drugs are prescribed medicines which some people abuse them by taking them when they have not been prescribed, there are laws and regulations about how these drugs should be stored and administered. 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. People have a number of activities available to them and enjoy varied and nutritious meals in a homely environment. Evidence: Individual plans of care seen contained life histories which detailed the significant events in peoples lives some information about their interests and hobbies. The home has a whippet which the residents were seen fussing and enjoying. Some people also had budgerigars in their bedrooms. Activities sheets were seen which contained a record of the activities that people had taken part in such as visits from friends and family, sing-a-longs with a local musician, reminiscence sessions, hairdresser visits and bingo. On the day of inspection people were seen reading the newspaper and taking part in a bingo session. Staff told us that visitors are welcome at any time. One person told us that she enjoys going to church with a friend. One person told us that she goes to a day centre one day a week. Care Homes for Older People Page 15 of 26 Evidence: The manager explained that people are able to use the computer in the dining room if they wish to and a large keyboard has been purchased to make it easier for people to use. The manager told us that people liked looking at photographs on the computer. Lunch was observed during the inspection. Staff were seen assisting people in sensitive manner, talking to them and explaining what the food was. One person told us that, the food is always good. The menu was seen and looked varied and nutritious. Staff explained that people were given a choice of two options for their main meal but if they did not want either of these they could request something else. 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 are safeguarded by good staff awareness and attitudes and by the homes policies and procedures. Evidence: The home has a complaints procedure which outlines what people should do if they wish to raise a concern about the home and the response that they can expect. A copy of this is kept in the lounge so that it can be accessed by people who live at the home and their visitors. The address detailed in the complaints procedure for the Care Quality Commission is not the current address. The manager said that the home has not received any complaints since the last inspection and has not made any alerts to the Local Authority under the locally agreed safeguarding adults procedure. Staff spoken to knew how to raise any concerns that they may have and had received training which outlined their responsibilities to safeguard people from harm. Staff told us that the home has not made any applications to the Local Authority under the deprivation of liberty safeguards. During the inspection we did not observe any restrictions being placed on anyone living at the home. 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. People benefit from living in a comfortable and homely environment. Evidence: The Yews is a detached period property with many period features such as exposed beams and oak panelled walls. Communal areas consist of a lounge, a dining room and a further quiet seating area by the front door. These areas had been made homely with flowers, pictures and ornaments. Patio doors lead from the lounge into a large, well maintained garden. There is a patio area near the property which people told us they can sit out on in the warmer weather. The home has two bedrooms downstairs, both of which are shared. There are a further eight bedrooms on the first floor, one of which can be used as a double but is currently being used by one person. Bedrooms seen had been made person with people being able to bring in pictures, ornaments and other items to make their room feel like their own. All of the rooms have either a wash basin or an en suite shower or bathroom. There is a further communal bathroom. None of the windows on the first floor were fitted with opening restrictors, this poses a risk that someone could fall out of the window. It was noted that some windows were Care Homes for Older People Page 18 of 26 Evidence: not easy to open or did not open at all. The majority of the radiators in the property have not been fitted with covers. A risk assessment was viewed that the manager had carried out to detail the potential risks to people if they fell against a hot radiator and the measures that the home have put in place to reduce this risk. The home was clean, hygienic and well maintained throughout. 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 benefit from being supported and cared for by staff who are competent, caring and have a good knowledge of their needs and preferences. Evidence: The recruitment of staff is well managed with all of the necessary pre recruitment checks being carried out to ensure that staff are suitable to work with older people. Staff told us that they had an induction when they first started working at the home which included working alongside an experienced colleague to make sure that they had all of the information that they need to do their job in the right way. Staff explained that they attend training courses such as food hygiene, safeguarding of adults, dementia care, infection control, fire safety and moving and handling. The staff are responsible for doing the cooking, cleaning and laundry as well as caring for the people who live at the home. Staff explained that one member of staff was allocated to do housekeeping duties each morning with the remaining two staff members being responsible for ensuring that the people who live in the home receive the care and support that they require and for cooking lunch. Staff told us that because The Yews is a small home they are familiar with peoples needs and preferences. Care Homes for Older People Page 20 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 home is managed in the best interests of the people who live there. Evidence: The two registered owners of The Yews live in a property within the grounds of the home. One of the registered owners is also the registered manager. Staff told us that the manager was very supportive to the staff team and actively involved in the running of the home. Records show that the necessary safety checks such as fire checks, checks on the water system and portable appliance testing have all been carried out recently. Hoists and lifting equipment has been serviced as per manufacturers recommendations. The manager told us that the home carries out satisfaction surveys. Blank forms were made available to people living at The Yews and their relatives in the lounge along with a suggestions box. The results of recently completed surveys viewed and were generally positive. Care Homes for Older People Page 21 of 26 Evidence: The manager explained that the home does not hold any money on behalf of anyone who lives their. It was noted in noted in one persons file that their relative had power of attorney. It did not, however, specify whether this was in relation to the the persons finances or health and welfare decisions. Care Homes for Older People Page 22 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 23 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 1 8 17 Where people have been identified as being at risk of developing pressure sores, their care plan must clearly state what the home is doing to care for the person in a way that reduces that risk. To ensure that people receive the appropriate care to prevent pressure sores developing. 18/12/2009 2 9 13 The storage of medication must be reviewed to ensure compliance with the latest requirements of the Misuse of Drugs Act Amendment 2007. To ensure that all medication, including any controlled drugs can be stored safely and legally. 19/02/2010 Care Homes for Older People Page 24 of 26 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 3 19 13 Any risks posed to people from the environment must be assessed and measures put in place to reduce the risk to an acceptable level. To ensure the health and safety of everyone in the home. 31/12/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 8 14 Care plans should be updated to reflect the current advice of visiting health professionals Records should clearly detail how a persons capacity to consent to specific decisions has been assessed and where someone is deemed not to have the capacity to make a decision, how any course of action has been assessed as being in their best interests. To make sure that people are given full assistance to make decisions where they are able to and if they are unable to that any decisions made on their behalf are made in their best interests in line with the Mental Capacity Act 2005. The home should ensure that where someone has given a relative or representative power of attorney it is clearly documented whether this relates to financial decisions, health and welfare decisions or both and whether any restrictions have been placed on the powers given. To ensures peoples rights and autonmy are respected. 3 35 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). 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