Care Home: Warwick House

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What the care home does well In the surveys returned to the Commission five people living at the home said that they always received the care and support they need. Two people spoken with at the inspection told us that `staff are kind and caring` and `I could not wish for any better staff.` People told us that they enjoyed the food available at Warwick House `the food is very nice.` They also told us that they have choices. Two people living at the home told us that Warwick House was always clean and they enjoyed the homely environment. The staff team observed at the inspection provided a friendly and caring environment for the people who live at Warwick House. What has improved since the last inspection? Our last visit highlighted a couple of areas for improvement. This visit confirmed that improvements have been made in these area. Three people`s care files viewed contained contracts regarding their residence at the home. Discussions with members of staff and information supplied to the Commission about the service confirmed that staff have received training in safeguarding. Over 50% of care staff have now achieved a National Vocational Qualification (NVQ). The sterilizing unit at this inspection was in working order. What the care home could do better: No requirements were made at this inspection visit. The service should carry on enhancing the service provided to people living at Warwick House. Key inspection report Care homes for older people Name: Address: Warwick House Bonsall Avenue Littleover Derby DE23 6JW     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: Rehana Rashid     Date: 1 9 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 25 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 25 Information about the care home Name of care home: Address: Warwick House Bonsall Avenue Littleover Derby DE23 6JW 01332718720 01332718720 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Derby.gov.uk Derby City Council care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: That 6 beds be registered for intermediate care only. Date of last inspection Brief description of the care home Warwick House is a 28 bedded home for older people situated in Littleover, a suburb of the city of Derby. The home has been refurbished to provide six places for intermediate care, with the eventual aim being to provide respite care in the remaining twenty-two places. Currently there are four residents living at the home on a longterm basis. The property was purpose built and is owned by the local authority, Derby City Council. The intermediate care bedrooms are situated on the ground floor and are en suite. The remaining resident bedrooms are situated on the first floor, which is accessed by stair lift and passenger shaft lift. A programme of redecoration and refurbishment of all bedrooms has been continued. There is a garden area with patio and outdoor seating. Support services are in place with a choice of General Practitioners, and visiting district nurses, chiropodist, dentist and optician. Community psychiatric nurse, occupational therapist, physiotherapist and dietician are accessed as required. Transport is arranged for those service users wishing to go out and in-house Care Homes for Older People Page 4 of 25 Over 65 28 0 Brief description of the care home entertainment is arranged. The fees for respite and short term care at the time of this inspection are £108.10 to £325.00 per week, whilst the intermediate care service is free at the point of delivery. Self funding people have an individual assessment to determine their weekly charges. Inspection reports and information about the service are avaliable by request. Care Homes for Older People Page 5 of 25 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 an unannounced inspection carried out by one inspector on 19 August 2009, which took place over five hours. The previous key inspection took place 09 October 2007. The main method of inspection was case tracking, which involved sampling three people and examine their care records. Case tracking is used to establish if the needs of the people living at the home are being appropriately assessed and their needs are being catered for. Discussions were held with four members of staff and two people living at Warwick House. Two staff files were also examined. A partial tour of the building was carried out which included viewing communal areas. Care Homes for Older People Page 6 of 25 Before the visit the registered manager submitted an Annual Quality Assurance Assessment (AQAA), which is a self assessment detailing what the home was doing well, what has improved since the last inspection and any plans for improving the service over the next twelve months. Information from the AQAA was used within this inspection report. We also sent out five surveys asking for views about the care and support people receive at Warwick House. Five surveys were sent out to members of staff working at Warwick House. We received all the completed surveys back. Prior to the inspection to assist with planning the AQAA, notifications and any other information received about the service were examined. Care Homes for Older People Page 7 of 25 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 25 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 25 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. Assessments are in place prior to admission to ensure peoples needs can be met by the service. Evidence: Information about the service was available including a service user guide and statement of purpose. The documents did need to be updated to included the name change of the regulator, which the registered manager agreed to do. People who move to the home are given an information pack which included information on advocacy service and a charges guide. People spoken with confirmed they had been given this information when they moved in. Five surveys were sent out to people who live at Warwick House. They were asked if they had received enough information to help them decide if the home was the right Care Homes for Older People Page 10 of 25 Evidence: place for them before they moved, four people said yes whilst one person made no comment. Comments included: My family looked at Warwick House before I moved in I have been to the home many times on respite In the information supplied in the pre-inspection self-assessment to the Commission about the service, the registered manager told us that all people who have a planned admission to the service have a full needs assessment and care plan before they move in. Three peoples care files were viewed these contained assessments and care plans containing information about their needs and the support required. Warwick House has one wing The Cherry Tree Unit which provides intermediate care. This is a service that aims to assist people to return home following a period of hospital care. Health care professionals including Occupational Therapists, Physiotherapist and community nurses offer support to the care staff on this unit. In the pre-inspection self assessment it stated that the service works with health care professionals to maintain peoples independence and individuality. Care Homes for Older People Page 11 of 25 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. Care plans contained detailed information which ensured that staff were able to support people in a safe way. Evidence: The registered manager told us in the information about the service how care plans are individualized. They said that people at the service have person centred care plans which are reviewed and updated to meet individual needs. Three peoples care files were looked at during this inspection. As stated in the information submitted about the service, these were completed in a person centred manner clearly documenting individual needs and preferences about how support is provided. The care plans for these three people were detailed containing information about their personal care, health care and social care needs, together with the level of support which is required. Comments on care plans included I will need assistance when bathing. Individual day and night care routines were specified on the care plans. Care Homes for Older People Page 12 of 25 Evidence: Where a risk had been identified risk assessment have been undertaken. Nutritional, moving and handling and general risk assessments were in place. As stated in the information supplied to the Commission all risk assessments are completed and changed according to individual needs. The care plans were reviewed and updated as required to reflect the changing needs of individuals. Care files viewed, contained records of visits by General Practitioners, District Nurses and other health professionals. Two people at the home told us that if they are unwell staff would contact the GP. One of the people at the home for respite said that the nurse has been to the home to see me. We found there were satisfactory systems in place for the safe storage, administration and handling of peoples medicines. Medication practices were looked at which demonstrated that people were receiving their medication as prescribed. The medication administration records for three people were looked at, there were no gaps in the recording. The manager spoken with stated that the night staff and managers were responsible for the administration of medication. In the five staff surveys returned to the Commission when asked if the training gives them enough knowledge about health care and medication all of them said yes. Evidence was seen confirming that refresher medication training has been arranged for staff to attend over the next couple of months. Throughout the inspection visit members of staff were observed supporting people at the home in a dignified and respectful way. Staff were observed talking to people in a friendly manner. In the surveys returned to the Commission five people living at the home said that they always received the care and support they need. Comments from two people spoken with at the inspection included staff are kind and caring and I could not wish for any better staff. They also told us that staff always knocked on their door before they entered their room. Care Homes for Older People Page 13 of 25 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 find the lifestyle experienced at the service meets their expectations and preferences. Evidence: The registered manager told us in the information supplied about the service that there is open visiting and they continue to facilitate access to local facilities including the church and shops. She also told us they encourage people to maintain relationships in the community. During the inspection people were observed watching television, talking to other people in the home and spending time with their visitors. One person stated in the survey that the staff welcome their family when visiting. Two people told us that the service does organize activities for people to take part in. One person said there are enough activities, but I like to spend time in my room which is respected. Another person told us that the routine in the home is flexible. Routines in the home were observed to be flexible. One person wrote in the survey I Care Homes for Older People Page 14 of 25 Evidence: feel free to come and go and pursue my own interests. When asked in the survey what the home could do better, one persons comment was more entertainment. Staff comments in the surveys were it would be nice to have more time to do the social side of things to have more time for activites and social activites could be improved, but need more staff. A list of activities was displayed in the service, which included bingo, quiz night and reminisces. Care plans we viewed contained information peoples social care needs and how people preferred to spend their time. In one care plan it stated I like to spend time in the day room. A hairdresser is available at the home once a week. In between meals staff were observed going round the home with the drinks trolley offering hot and cold drinks. The surveys returned by the people using the service further confirmed that the meals provided were enjoyed. Comments included: I am happy with the meals The food is very good The dining area was clean and the tables were presented with tablecloths making it homely. The lunch time meal was observed, staff were seen offering people choices. Two people spoken with told us that they have choices and meals are very nice. During lunch the atmosphere was relaxed, with staff being present in the dinning area. Care Homes for Older People Page 15 of 25 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. Systems in place ensure people have confidence to raise their concerns and they are safeguarded from harm. Evidence: The complaints policy was displayed throughout the home. In the pre-inspection information about the service the registered manager told us that they respond to complaints quickly and they are followed through to a satisfactory conclusion. Two people told us that they have had no reason to make a complaint and they said they would not hesitate to raise any concerns with the the staff team. In all the surveys returned by the people using the service confirmed they knew how to make a formal complaint. We looked at the complaints record this confirmed that the service had not received any complaints since our last visit. In the information submitted to the Commission prior to the inspection visit, they told us that in the last twelve months staff had undertaken training in safeguarding adults. Staff spoken with had a good understanding of the safeguarding procedure to follow should they suspect or witness a safeguarding issue. A copy of the derby and Derbyshire safeguarding adults policy and procedure was available at the service. Since the last inspection visit the service has had no safeguarding investigations. Care Homes for Older People Page 16 of 25 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 live in a clean, comfortable and homely environment that suits their needs. Evidence: The registered manager told us in the information supplied about the service that they provide safe accessible and comfortable areas. She also told us that the building is kept in a good state of repair which also includes all equipment, furnishings and garden. Two people living at the home told us that Warwick House was always clean and they enjoyed the homely environment. They told us that they were happy with the environment the home is always beautiful and clean and it is always spotless and very clean. In all of the surveys returned by people who live at the home they told us that the home was always fresh and clean. One person wrote the home provides a safe and warm environment. There is a lift in the home for people to be able to access the first floor rooms. A requirement made at the last inspection has been addressed. This related to the sterilizing unit, at this inspection this was in working order. The laundry room Care Homes for Older People Page 17 of 25 Evidence: contained suitable equipment ensuring that the laundry needs of people living at the service are met. We undertook a brief tour of the building. From observation all communal areas viewed were clean, homely and comfortable. Staff were seen cleaning the home during the inspection. Care Homes for Older People Page 18 of 25 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. Staff have been recruited professionally and are trained to meet the needs of the people living at Warwick House Evidence: At the time of this inspection the rota showed that there were sufficient staff on duty to meet the needs of the people using the service. Comments received from people living at the service reflected that staffing levels were adequate. In all five staff surveys received members of staff stated that there are usually enough staff to meet the individual needs of all the people who use the service. Comments on two surveys included sometimes struggling with staff shortages and we need more regular relief staff. Two members of staff spoken with at the inspection told us that most of the time there are enough staff on duty. In the information supplied to us the manager told us that have recently taken on two extra relief staff to provide cover. Two staff files were seen at this inspection and demonstrated that through recruitment practices are in place. Recruitment checks that are required by law had taken place Care Homes for Older People Page 19 of 25 Evidence: including Criminal Records Bureau Checks (CRB). All five staff surveys received confirmed that their employer carried out checks such as CRB and references before they started work. In the information supplied to us about the service the registered manager told us that they have a comprehensive induction program. Also all staff complete training to a high standard and it is regularly updated. Four staff told us in the surveys that the induction covered everything they needed to know very well, whilst one member of staff said that it mostly did. Four members of staff spoken with told us that they received training. Training records viewed for two members of staff showed that they had received mandatory training as well as other training including Mental Capacity Act. All five staff surveys confirmed that they were given training that is relevant to their role which helps them understand and meet the individual needs of people. In the information supplied by the registered manager it stated that 12 members of staff had achieved the National Vocational Qualification (NVQ) at level 2 or above. Two people living at Warwick House made positive comments about the staff at the home. They told us that staff were caring and friendly. Care Homes for Older People Page 20 of 25 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 health, safety and welfare of people and staff is promoted and protected at Warwick House. Evidence: The manager at Warwick House is registered with the Commission. In the information about the service it stated that all managers motivate staff and manage health and safety effectively. Two staff members spoken with told us that the management at Warwick House are supportive and approachable management cannot be faulted they are good. Staff surveys were complimentary about the management at the home. All five surveys stated that the manager gives them enough support. One commented that we have a very good staff team. The annual quality assurance assessment (AQAA) provided by the home was clear and Care Homes for Older People Page 21 of 25 Evidence: gave us all the information we asked for. Warwick House have a quality assurance system in place which enables people using the service to express their views about the service. Some comments in the surveys received by the service stated excellent staff, residents are well looked after, I would rate overall quality of the service as excellent and everyone is helpful. There is a system in place for the safe keeping of peoples personal spending money. We checked the records for two people and they were found to be satisfactory, this ensured that their money was safeguarded by the home. Four staff members spoken with confirmed that they received regular supervision. We looked at two staff files both contained supervision records. A sample of service certificates were seen at the inspection which confirmed that maintenance checks were undertaken regularly. Care Homes for Older People Page 22 of 25 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 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 12 The registered person should consider having a specific person to coordinate social activities. Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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