Care Home: Yoakley House (Michael Yoakley`s Charity)

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What the care home does well Yoakley House provides care and support for up to 26 older people. The home is set in attractive and well-maintained grounds and is part of a charitable organisation. The home is purpose built and is a single story building ensuring easy access throughout for all service users. It provides excellent accommodation for the individual and collective needs of the service users with a good range of communal space, adapted toilets and bathrooms and generous, personalised individual accommodation. There is a robust and detailed pre-admission assessment process that ensures all necessary information is gathered in order that the needs of service users can be met. Service users spoke positively about all aspects of the home and stated that they are able to retain control of their lives and are able to make decisions affecting their daily routines. One person said, `I love it here, it`s a great place. The staff are wonderful and the food is good.` The service has established a clear complaints process the details of which are provided to all service users and their representatives. A complaints book and a compliments book are accessible at all times for people to register any issues that they may have. Service users stated that they would know how to complain and that staff are approachable. All staff receive training in adult protection issues and demonstrated a good understanding of this topic. One resident said, `I have absolutely no complaints, there is nothing I would change.` Almost all of the staff team have achieved at least a National Vocational Qualification (NVQ) at level 2 or above and there is a training manager who ensures that all staff receive mandatory training and attend other service specific course. The home has a dedicated training room enabling much of the training to be provided on site. Quality monitoring processes are in place including regular audits of key areas, monthly monitoring visits and satisfaction surveys for service users, relatives, professionals and staff. There is an excellent activities programme that provides opportunities for all to be involved in a diverse range of pastimes including regular groups and sessions, trips out, visiting entertainers and one to one activities. A monthly newsletter is sent to all residents so that they are aware of upcoming activities. All records relating to health and safety in the service were up to date and well maintained and medication processes adhered to. What has improved since the last inspection? The service is in the process of introducing a computerised care planning system which will promote greater consistency and depth to the plans of care, risk assessments and healthcare monitoring. A new manager was appointed to the home in October 2009 who has made a positive impact on the service. Staff and service users spoke positively about her management style and attitude. She is in the process of registering with the Care Quality Commission. What the care home could do better: One recommendation was made as a result of this inspection process. It is recommended that the service introduces clear protocols for the use of PRN `as required` medication ensuring that there is a consistency in the administration of such medications. The care planning and risk assessment processes currently in use are suitable, but not ideal. However the manager and executive manager have identified these shortfalls and are in the process of introducing new systems including a computer-based planning process and a back-up written version. Key inspection report Care homes for older people Name: Address: Yoakley House (Michael Yoakley`s Charity) Yoakley House Via Drapers Close St Peter`s Road Margate Kent CT9 4AJ     The quality rating for this care home is:   three star excellent 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: Joseph Harris Date: 1     1 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: Yoakley House (Michael Yoakley`s Charity) Yoakley House Via Drapers Close St Peter`s Road Margate Kent CT9 4AJ 01843223652 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): michaelyoakley@aol.com Michael Yoakley`s Charity Name of registered manager (if applicable) Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 26 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category (OP) Date of last inspection Brief description of the care home The Home was purpose built in the 1980s in a semi-rural location. It is a short journey to the local amenities and is situated on a bus route. The local general hospital is situated next to the Home. The Home is registered 26 male & female service users of both genders, aged 65 years plus. The Home is all on one level and all bedrooms are single with en-suite facilities. Care Homes for Older People Page 4 of 26 Over 65 26 0 Brief description of the care home Information about the current scale of charges are summarised in the service user guide and are available on request from the service. 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: three star excellent 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 key unannounced inspection process culminated in a site visit to the service on the 10th November 2009. The visit commenced at 10:00 hours and lasted for approximately 6 hours. Prior to the inspection visit a range of records and documentation were examined as part of the pre-inspection planning process. These included the Annual Quality Assurance Assessment (AQAA) completed by the service, previous inspection reports, information received from others about the service and any notifications detailing untoward occurrences and events. We also reviewed any complaints, concerns and allegations made in connection with the service. The AQAA is a self-assessment document completed on a yearly basis by the service which summarises improvements made and planned and allows the service to identify any things that they could do better and how they plan to address these issues. The AQAA focuses on the outcomes for service users and also provides statistical and numerical information about the home. The service completed their AQAA in good detail and it provided all of the information that we asked for. Care Homes for Older People Page 6 of 26 During the course of the site visit discussions were held with service users, visitors, the manager, the executive manager and care staff. A tour of the premises was undertaken and staff were observed in their practice and interactions with service users. Records and documentation was examined including those relating to service users, staff, health and safety, medication and quality monitoring amongst other things. 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: One recommendation was made as a result of this inspection process. It is recommended that the service introduces clear protocols for the use of PRN as required medication ensuring that there is a consistency in the administration of such medications. Care Homes for Older People Page 8 of 26 The care planning and risk assessment processes currently in use are suitable, but not ideal. However the manager and executive manager have identified these shortfalls and are in the process of introducing new systems including a computer-based planning process and a back-up written version. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of prospective service users are assessed and people are able to make an informed choice about moving into the home. Evidence: The home has a clear statement of purpose and a service user guide in place. The guide provides prospective service users with a good level of information to enable them to make an informed choice about the service. Prospective service users are provided with a copy of the guide at the point of referral. The service users guide and the statement of purpose are reviewed and updated on an annual basis. The service has a well developed pre-admission assessment process that involves gathering information from care managers and/or referrers including needs assessments, care plans and risk assessments where possible. In the case of private referrals information is gathered from relatives and significant others. Prospective service users are involved in the assessment process and the manager visits people in their current accommodation to assess their needs. Two examples of the preCare Homes for Older People Page 11 of 26 Evidence: admission assessment process were examined and both were completed in good detail. The service does offer intermediate and respite care. 5 new dedicated respite care rooms have recently been completed for this purpose. Service users receiving respite care are encouraged to take an active part in the social aspects of the home. The manager stated that people receiving short-term care have their needs assessed in accordance with the admission process. 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. The health and personal care needs of service users are met. Evidence: All service users have a plan of care developed addressing all of their care and support needs in sufficient detail. Three individual service user plans were examined during the site visit. The level of information in these plans ensure that staff are able to meet the needs of the service users in a consistent manner. The current format of the plans is somewhat disjointed, but the manager stated that she is currently developing a more coherent system of written care plans. In addition to this the service manager was able to demonstrate that the organisation have invested in a computer based care planning system, which is currently being developed and trialled by the service. Service users are involved in the care planning process and the plans are reviewed and updated on a monthly basis or as required. The home maintains records of healthcare input from professionals and completes key assessments covering service users healthcare needs. The current system for recording the outcomes of health care appointments is under review. All service users are registered with local GPs and it was reported that the home receives good support Care Homes for Older People Page 13 of 26 Evidence: from community healthcare professionals. Complimentary healthcare needs are addressed and service users have access to chirpodists, dentists and opticians amongst other services. Care staff were observed to treat service users in a respectful and dignified manner and service users spoken to spoke highly of the staff with regard to both their attitudes and quality of support. The home has established medication processes that are generally well managed. Administration records are maintained and up to date and storage facilities are suitable for purpose. A number of relatively minor issues were discussed with the manager to promote safe administration of medications. The home should develop clear protocols for the use of PRN as required medication and all eye drops should have a date of opening written to ensure that they are not used outside their expiry date. Refer to recommendation 1. 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. Service users have a lifestyle that suits their needs. Evidence: There is a very good range of activities open to the service users in the home ranging from daily events to outside entertainers visiting the service. The home publishes a monthly newsletter for residents with details of all upcoming activities. The activities co-ordinator has developed a programme of activities and ensures that all service users has opportunities suited to their needs and wishes. Amongst the groups organised are quizzes, bingo, exercise classes and a knit and natter group. Singers, musicians, choirs and comedians have visited the home over recent months and the service explores alternative opportunities and entertainers. Residents commented positively about the variety of activities in the home and some people said that they choose to spend more time in their rooms, but will attend groups if they want to. In response to surveys taken from residents the home has increased the level of opportunities for trips out. Service users are also encouraged to use the substantial and attractively maintained gardens surrounding the home. Relatives and visitors are welcomed into the home and one visiting relative said, there is always a warm welcome, it is a pleasure to come here. Residents were also extremely positive about the quality of the food in the home. One Care Homes for Older People Page 15 of 26 Evidence: person said, the food is excellent, it is always well cooked and presented. I think the cook does an excellent job. A discussion was held with the cook who confirmed that all of the equipment in the kitchen is in good working order and she is also able to purchase and order good quality food. Menu records are maintained demonstrating that a healthy, balanced diet is provided with choices available at each mealtime. Special diets are catered for including those required for cultural and health reasons. The lunchtime service was observed, staff were unhurried and relaxed and there was a social and convivial atmosphere. Residents can choose to eat in the dining room or in their rooms dependent on individual choices. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The views of service users are listened to and acted upon. Service users are protected from abuse. Evidence: There is a clear complaints process in place that is summarised in the service user guide and displayed within the home. The manager stated that she operates an open door policy and encourages service users and visitors to raise any concerns that they may have. A complaints book and a compliments book are openly available at all times. No complaints have been reaised in connection with the home since the last inspection. One service user said, I have absolutely no complaints, i think the home is wonderful. Another person said, I would feel comfortable in raising any concerns, not that ive ever had any. Policies and procedures are in place relating to adult protection and abuse awareness. all staff have attended courses covering these topics and they demonstrated a good awareness of these issues. Information is available relating to the Mental Capacity Act and the Deprivation of Liberty Safeguards (DOLS) and a DOLS checklist has been completed for all service users. No adult protection alerts have been raised in connection with the service since the last inspection process. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a conducive environment suitable for the collective and individual needs of the service users. Evidence: A tour of the premises was undertaken. Throughout the home the accommodation, facilities and decor is of a high standard, this was underlined by the levels of satisfaction service users stated about the home. There is a good range of communal space including two lounge areas, a dining room and quiet areas around the home. The service users bedrooms are spacious and well furbished. They have been personalised to a good degree and provide a comfortable and conducive environment meeting individual needs. All bedrooms have en-suite facilities and there are sufficient toilets and bathrooms including assisted baths throughout the building. The home is surrounded by very attractive and well maintained gardens and there is parking space available within the grounds. The kitchen and laundry facilities are suitable for the needs of the home and are clean and well maintained. It was reported that all equipment is in good working order. Service users said, this is a lovely place to live. I really like my room. I have a print of the garden showing the view from my favourite place. The home is so clean and well cared for. A new annexe has recently been built with a state of the art training room and additional office space. 5 new dedicated respite rooms have also been created. There Care Homes for Older People Page 18 of 26 Evidence: are two full-time maintenance men and there is evidence of on-going improvement. The home is purpose-built and is a single story building enabling easy access 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a well trained and competent staff team. The staffing complement is suitable for the needs of the service users and recruitment procedures ensure the well-being of residents. Evidence: The staffing levels in the home ensure that the needs of the service users can be met at all times. The home operates with 6 care staff every morning and 4 care staff in the afternoon with 3 waking night staff. Both staff and service users stated that there are sufficient staff on duty every day. The staff rotas for two weeks were examined demonstrating this fact. The manager stated that if the needs of service users change more care staff can be brought on shift. It was stated that staffing levels have recently been increased. There are ancillary staff to complement these numbers including a cook on duty every day, an administrator, housekeepers and two full-time maintenance men as well as an activities person. The home is currently in the process of employing a dedicated activities co-ordinator. Almost all of the care staff have achieved at least a National Vocational Qualification in care at level 2 or above. The only staff who have not done so are those that have recently been employed. A number of staff members were spoken to during the course of the site visit, all of whom demonstrated a good understanding of the needs of service users and related issues. The home operates a robust recruitment process and three staff personnel files were Care Homes for Older People Page 20 of 26 Evidence: examined demonstrating that all of the required checks had been completed prior to employment including the receipt of two written references, CRB and POVA checks and proof of identity amongst other documents. All new staff work through an induction process co-ordinated by the training manager. The induction process is based on the Common Induction Standards and examples of completed induction packs were examined. Care staff confirmed that they work through this process in a timely manner. An up to date staff training matrix was examined demonstrating that all staff have received the required mandatory training and updates as required. The training manager is a trained trainer in a number of the mandatory training topics and can, therefore deliver this training as and when new staff join the company and refresher training is required. The manager is also a trained trainer in the Mental Capacity Act. She stated that she plans to deliver this training in the future. Additional service specific training is provided based on the needs and requirements of the service users. With the newly developed training room the service is able to deliver all required training in a conducive setting with the benefit of multi-media resources. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed in the best interests of the service users. Health and safety practices are maintained. Evidence: A new manager was appointed in October 2009. She is currently in the process of applying for registration with the Care Quality Commission. She is working towrds her NVQ 4/Registered Managers Award and has a number of years of management experience working in the care home sector. Through discussion and feedback it was evident that she has had a positive influence on the home and has already introduced a number of innovations to further improve the service. Staff and service users spoke positively about her attitude and management style and she has developed and fostered good relationships within the service. Supervision systems have been reviewed and updated by the manager to ensure that all staff receive regular formal supervision at least 6 times per year. Supervisory responsibilities are shared out between the manager and the training manager. Both supervisors frequently provide hands-on care and are able to ensure supervised Care Homes for Older People Page 22 of 26 Evidence: practice. Care staff stated that they feel supported in their roles and that they are able to approach the manager at any times should they have any concerns, worries or issues. The organisation has developed good quality monitoring processes. The executive manager works within the building and, in conjunction with the trustees of the organisation, ensures the on-going monitoring and development of the service through monthly monitoring visits and other frequent visits. Service users, staff, relatives and professionals are surveyed every 6-12 months and the feedback is collated within a report demonstrating any actions taken as a result of this feedback. The service does not act as a financial appointee for any service users, these responsibilities are taken on by people independent of the home if required. A safekeeping service is offered and records and receipts of all transactions are maintained. Records relating to health and safety issues were examined including service safety certificates, fire safety logs and accident records. All documents examined were up to date demonstrating safe working practices. Policies and procedures are in place promoting health and safety practices. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 10 To develop protocols for as required medication and ensure medication processes are in accordance with Royal Pharmaceutical Society of Great Britain guidance for care homes. 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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