Care Home: Vishram Ghar

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What the care home does well Residents and relatives told us they were pleased with the staff team. The following comments were made, `Everyone looks after me nicely`, `The staff are very good and helpful`, and `The staff provide good care.` An Acting Manager is presently in charge of the home. She has 10 years experience in care and has worked hard to bring about the recent improvements to the service. One of the carers told us, `The Acting Manager is very approachable, she helped me with my training when I first came here.` The range of activities in the home and the involvement with religious groups helps to ensure residents have plenty to do and are not isolated from the local community. Religious days, for example Vaisaki, Eid, Diwali, and Christmas, are celebrated in the home with special meals and entertainment provided. Visitors are welcome at the home at any time and two monthly residents and relatives meetings are held. These are well-attended and give residents and relatives the opportunity to talk to staff about the home and make suggestions. A number of diets are catered for including Gujarati, Punjabi, Halal, salt-free. diabetic, and pureed. The home has two kitchens and two dining rooms, so both vegetarian and meat dishes can be prepared and served separately. A relative told us, `The food is very nice`, and a member of staff said, `Residents enjoy their food at mealtimes.` What has improved since the last inspection? Care plans have been re-written by the Acting Manger and improved substantially. One member of staff told us, `We try to provide everything the service users demand or choose.` A new Activities Organiser puts on a varied programme of activities including exercise classes, cards and board games, singing, walks, religious activities, and films. One of the kitchens has been refurbished, there are new floor coverings in one of the corridors and in four bedrooms, and a new shower room. Photos have been displayed on the walls and a designated room provided for hairdressing and podiatry. Extra staff have been added to existing shifts and a new shift added. A carer said `I`m happy with the staff we have now, we are no longer rushed off our feet.` What the care home could do better: The home`s safeguarding procedure needs updating and improving. Some areas of the home look institutional and shabby and are in need of improvement to make the premises more homely for residents. The home is still without a Registered Manager. Some bedroom doors are being propped open and this needs addressing to reduce risk to residents.  Key inspection report Care homes for older people Name: Address: Vishram Ghar 120 Armadale Drive Netherhall Leicester LE5 1HF     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: Kim Cowley     Date: 1 0 0 6 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 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Vishram Ghar 120 Armadale Drive Netherhall Leicester LE5 1HF 01162419584 01162432745 mahesh@pattani.plus.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): BestCare Limited Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 40 The registered person may provide the following categories 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: Old age, not falling within any other category Code OP Dementia - Code DE Mental Disorder - Code MD Physical Disability - Code PD Date of last inspection 0 5 0 1 2 0 1 0 40 40 0 40 Over 65 0 0 40 0 Care Homes for Older People Page 4 of 28 Brief description of the care home Vishram Ghar is an Asian lifestyle care home registered for up to forty older persons, some of whom have dementia, physical disabilities, or mental health issues. The property is situated in the residential area of Netherhall, close to shops and other facilities and is easily accessible by private and public transport. The home consists of two floors and has both stairs and a passenger lift. All bedrooms but one are single, and two have en-suite facilities. Further information about the home, including the fees, is available from staff. The homes Statement of Purpose and Service Users Guide are available in English, Gujarati, Punjabi, and can also be made available in other languages. 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: This was a key inspection that included a visit to the home and inspection planning. Prior to the visit, we (throughout the report the use of we indicates the Care Quality Commission) spent half a day reviewing information relating to the home. During the course of the inspection we checked the key standards as identified in the National Minimum Standards. This was achieved through a method called case tracking. Case tracking means we looked at the care provided to three residents living at the home by meeting them; talking with the staff who support their care; checking records relating to their health and welfare; and viewing their personal accommodation as well as communal living areas. Other issues relating to the running of the home, including health and safety and management issues, were examined. We also talked to four other residents and two relatives, the Acting Manager, Owner, General Manager, and two seniors and three Care Homes for Older People Page 6 of 28 care assistants. Nine surveys from residents and relatives, and four from staff, were returned to CQC prior to the inspection. All respondents made many positive comments about the home. Some of these are quoted in this report. 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: The homes safeguarding procedure needs updating and improving. Some areas of the home look institutional and shabby and are in need of improvement to make the premises more homely for residents. The home is still without a Registered Manager. Some bedroom doors are being propped open and this needs addressing to reduce risk to residents. Care Homes for Older People Page 8 of 28 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 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are assessed prior to admission to ensure the home is suitable for them. Evidence: People who are interested in coming to Vishram Ghar are invited to visit prior to making a decision. The Acting and General Managers assess all prospective residents in their own homes, in hospital, or during a visit to Vishram Ghar. The assessment process helps to ensure the home is suitable for residents who are considering living there. Records relating to three recent admissions were examined. All were of a good standard and the views of relatives, and assessments carried out by health and social services staff, had been taken into account. The Acting Manager said that when they move into the home all residents are Care Homes for Older People Page 11 of 28 Evidence: assigned a senior carer who helps them to settle in. Residents specify at the assessment stage whether they require a male or female member of staff for personal care. Standard 6 was not inspected, as this home does not provide intermediate care. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health and personal care needs are identified and met. Evidence: All care plans have been re-written by the Acting Manger and have improved substantially. They are now more person-centred, and give clear instructions to staff about how best to care for the residents. Those we looked at were comprehensive and of a good overall standard. At this last inspection we were concerned that care plans for residents with dementia were not detailed enough. This is no longer the case and they now contain sufficient information to help ensure that needs are promptly met. One member of staff told us, We try to provide everything the service users demand or choose. Care plans are written in English. The Acting Manager said it is not practicable, at present, to have them translated into other languages. She told us that care plans were explained to residents (or their families, where appropriate) in their own language if necessary. Care Homes for Older People Page 13 of 28 Evidence: At present a GP visits the home weekly to provide health care to residents. District Nurses visit individual residents several times a week. Records showed that residents have access to a full range of health care treatment including input from CPNs, chiropodists, dentists (NHS and private), and opticians. Records health care appointments are kept up to date. Since the last inspection medication policies and procedures have been re-written and all staff who administer medication re-trained. The medication room has been refurbished and new storage facilities installed. The Acting Manager is trained in Dignity in Care and uses person-centred plans (see above) to help ensure that staff treat residents with respect, and help to maintain their dignity by providing care discreetly and sensitively. 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. Residents social and cultural needs are identified and met. Evidence: The home now employs an Activities Organiser for three days per week. She provides a varied programme to residents on both a group and one to one basis. Activities taking place during the week of inspection included exercises classes, cards and board games, singing, walks, religious activities, and films. One resident enjoys gardening with the Acting Manager. A staff member said, The home does a lot of activities well. Religious days (for example, the 11th day of the monthly lunar for Hindus) are observed by preparing special meals for the occasion. For Sikhs, Vaisaki is celebrated, as is Diwali, Eid, and Christmas for other faiths . Birthdays and other special days are also celebrated. Some residents attend places of worship with staff from the home or relatives. Once a month a multi-faith religious celebration is held in the home with music and prayers. The range of activities in the home and the involvement with religious groups help to ensure residents have plenty to do and are not isolated from the local community. Staff are trained in Diversity and Equal Opportunities to help them provide a flexible Care Homes for Older People Page 15 of 28 Evidence: service that meets residents individual needs. Visitors are welcome at the home at any time and two monthly residents and relatives meetings are held, sometimes at weekends to ensure maximum attendance. The Acting Manager told us that menus are a popular agenda item at these meetings and one of the cooks always attends to listen to suggestions and comments about the food served. A number of diets are catered for including Gujarati, Punjabi, Halal, salt-free. diabetic, and pureed. The home has two kitchens and two dining rooms so both vegetarian and meat dishes can be prepared and served separately. At mealtimes residents sit in small groups at individual tables. The food is homemade and healthy eating is encouraged. A relative told us, The food is very nice, and a member of staff said, Residents enjoy their food at mealtimes. 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. Residents and their relatives are encouraged to talk to staff about any concerns they might have. The homes safeguarding procedure needs updating and improving. Evidence: The homes complaints procedure and form have been redesigned and produced in English as well as Asian languages to make it easier for people to complain. It is given to all residents (and their representatives) prior to admission. All the residents and relatives we spoke to said they knew what to do if they had a complaint. Residents comments included, I am happy with the home and have nothing to complain about, Everyone listens to me here, and Staff and management do listen to us. Concerns can also be raised at the regular (two-monthly) residents and relatives meetings. And residents and relatives can speak to the Acting Manager, or any staff member, in private if they wish to discuss anything they are not happy about. There have been no complaints since the last inspection. The home has a safeguarding procedure in place which tells staff what to do if they have concerns about the way a resident is being treated. This procedure must be updated to explain the role of social services as lead agency during safeguarding Care Homes for Older People Page 17 of 28 Evidence: investigations. It should also be simplified as at present it is complicated and difficult to follow. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are needed to the premises which are currently shabby and institutional in places. Evidence: The premises have been improved since the last inspection, although there is still work to be done in some areas. Improvements include refurbishment of one of the kitchens, new floor coverings in one of the corridors and in four bedrooms, and a new shower room. Residents and relatives had asked for photos of activities to be displayed in the home and this has been done. They also requested better facilities for hairdressing and podiatry, and a designated room has been provided for this. However some areas of the home still look institutional. Although the entrance hall is homely, other communal areas are relatively bare. The homes paintwork is mostly one colour and there are few pictures, ornaments, or other forms of decoration. Some furniture is broken and needs repairing or replacing. Paintwork is chipped and worn in places. The environment must be re-decorated and re-furbished where necessary and made more homely for residents. An audit should be carried out to identify which areas are in need of attention. When planning improvements, residents and relatives should be involved in choosing new colour schemes and other changes to the home. Care Homes for Older People Page 19 of 28 Evidence: Consideration must also be given to making the environment more suitable for people with dementia, with expert advice sought where necessary. On the day of inspection most areas of the home were clean and fresh. However there was an odour coming from an unoccupied bedroom on the first floor. This was discussed with the Acting Manager who said she was aware of the problem and that a new floor covering would be provided before the room was used again. 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. There are enough staff to meet residents needs. Those employed are well-trained and supervised. Evidence: Surveys showed that residents and relatives had been concerned about a shortage of staff in the home. However the situation has now improved, and extra staff have been added to existing shifts and a new shift added. This means that staff now have more time to spend with residents. The Acting Manager told us, There was lot of problems with not enough staff but that has now improved. A carer said Im happy with the staff we have now, we are no longer rushed off our feet. Residents and relatives told us they were pleased with the staff team. The following comments were made, Everyone looks after me nicely, The staff are very good and helpful, and The staff provide good care. The homes recruitment policy states that all staff are subject to CRB and SOVA checks, and references are obtained. This helps to ensure residents are safeguarded. Staff receive good training opportunities. The home is registered with Skills for Care and training courses are ongoing. Records showed that staff are encouraged to develop their existing skills and learn new ones. In addition all staff have supervision Care Homes for Older People Page 21 of 28 Evidence: sessions with the Acting Manager. The training and supervision arrangements in the home help to ensure that staff are competent to do their jobs. 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 home still does not have a Registered Manager. The fitting of door guards would improve resident safety in the home. Evidence: An Acting Manager is presently in charge of the home. She has 10 years experience in care and has worked hard to bring about the recent improvements to the service. One of the carers told us, The Acting Manager is very approachable, she helped me with my training when I first came here. The Owning Bodys General Manager is based in the home and takes an active role in its running. The home is still without a Registered Manager. The Acting Manager, or another suitable person, should be put forward to CQC for the role. This will help the home to meet its legal responsibilities. Quality assurance questionnaires are distributed annually to residents, relatives, and other stakeholders to give them an opportunity to comment on the home. The two monthly residents and relatives meetings also provide a forum for them to give their views. Changes to the environment and to the homes Care Homes for Older People Page 23 of 28 Evidence: menu have been made in response to requests from residents and relatives. The home will look after small amounts of money for residnets and records showed this is properly accounted for with two staff signing each time a deposit or withdrawal is made. When we toured the premises we found some bedroom doors propped open. Risk assessments have been carried out for these. The Responsible Individual told us the home intends to fit door guards (devices that close doors automatically if the fire alarm goes off). This should be done as soon as practicable as it will reduce risk to residents, and allow them more freedom to move about the home. 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 18 13 The safeguarding procedure must be updated to explain the role of social services as lead agency during any safeguarding investigation. It should also be simplified as at present it is complicated and difficult to follow. To help ensure that staff know what to do if they have concerns about the way a resident is being treated. 09/08/2010 2 26 23 The environment must be re-decorated and refurbished where necessary. To make it more homely for residents. 09/10/2010 Care Homes for Older People Page 26 of 28 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 31 38 The Acting Manager, or another suitable person, should be put forward to CQC for registration. Door guards should be fitted where necessary to reduce risk to residents. 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. 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