Culwood House

Culwood House is family owned and operated care home without nursing operated since 1988. The service is situated in a quiet residential area of Chesham. People who used the service are older adults, some of whom have a dementia diagnosis. This is the single location within the provider’s current registration. At the time of our inspection, 17 people lived at Culwood House.

People’s experience of using this service:

People received safe care. Any risks to them were assessed, documented and mitigated to protect people from avoidable harm. Staff were knowledgeable and skilled. They were competently able to provide the support people required. People and relatives described the service as caring and staff as kind. People’s care was specifically tailored to their individual needs. The service was well-managed. There was a positive workplace culture. The registered manager ensured audits and checks were completed regularly to ensure the safety and quality of people’s care.

Rating at last inspection:

At our last inspection the service was rated good. Our last report was published on 9 July 2016.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

For more details, please see the full report which is on our website at www.cqc.org.uk

This inspection took place on 25 and 26 May 2016 and was unannounced.

The service was previously inspected on 3 and 8 April 2014. During this inspection it was found that records were not maintained accurately. The provider had since put a robust system in place to ensure people’s records accurately reflect the care given. The follow up inspection carried out in June 2014 found the provider to be fully compliant.

Culwood House was established as a residential care home for the elderly in 1988. It is a two story-Victorian building situated in the beautiful countryside of the Chilterns. The home is registered to accommodate19 people who require nursing or personal care.

All the bedrooms are en-suite; people are able to personalise their rooms by bringing in their own pieces of furniture, bedding and pictures. People had access to a communal lounge, dining room and conservatory as well as a large garden and two summer houses (one of which doubles as a relatives room so relatives can stay overnight if required). There are two specialist bathrooms where people may be assisted with equipment such as hoists to enable them to bath safely.

Visitors are welcome at any time within reason also well behaved pets at the management’s discretion.

At the time of our inspection there were 16 people living in the home. There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People said they felt safe living in the home. One person said, “There’s someone in and out all the time”. A visiting relative said “Its family run and it’s all about the people living here”.

Prior to admission people were assessed to see if the home can meet the needs of the person. Once it has been established that the home can offer the care necessary, a care plan was put in place. Each care plan was individualised to meet the needs of the person receiving care. Care plans were reviewed monthly and updated every three months or sooner where necessary.

People were cared for by an established, motivated and well trained staff team.

The full and part time staff consists of a team of 16 care staff one cook, and one administrator. All new care staff were expected to complete a 'Care Certificate' as part of their induction and this is usually completed within three months from the start of their employment.

Culwood House provided a range of leisure and social events for people. Staff supported and encouraged people to engage with a variety of activities and entertainments available within the home.

The service had a complaints policy for people to view when they were given the service user guide on admission. People were invited to give their opinions at all times and at a monthly resident’s forum. Feedback was invited once a year by way of a resident questionnaire. This was extended to relatives, staff and medical professionals.

There were services available for people including a GP, district nurses, chiropodists, dentists and opticians. A hairdresser visits on a weekly basis.

Professionals who visited regularly at the service told us, “I like coming here, it’s clean, and tidy with lots going on I have no concerns”.

The provider wrote to us and provided us with an action plan. They informed us they had reviewed the standard of record keeping and put a system in place to regularly monitor people's care records. This had involved the creation of a resident responsibility rota which gave staff the responsibility to complete a maximum of six care plans when they were on shift. The provider had also reviewed the structure of people's care plans and condensed the information held in twenty sections to a more manageable twelve sections. This provided staff with more user friendly care plans to work with.

We were provided with documentation to show weekly audits had been undertaken. We were also supplied documentation to show actions had been taken where any shortfalls in record keeping had been found.

The audits evidenced after five weeks of monitoring people's care and support records vast improvements had been made. This showed the systems in place were effective. This meant people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and knew who to speak to if they had concerns. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). Staff were trained to understand when an application should be made. We were told of a person who had recently left the service and had a DOLS in place. Correct procedures had been followed in the best interests of the individual.

Is the service effective?

The provider had safe and thorough recruitment procedures in place and appropriate checks had been undertaken before staff began work.

Is the service caring?

People said they were happy with the care and support and their needs were met well. Staff had a good understanding of people's needs and knew them well. We saw an example in which one person did not want the lunch offered and a suitable alternative was provided at their request.

Is the service responsive?

People were offered a range of activities in and outside the home regularly. One person told us they access the local church and volunteers from the church collect them and return them after the service.

Is the service well led?

The provider had systems in place to regularly assess and monitor the quality of service people received. People's opinions were regularly sought through monthly forums, questionnaires, reviews and on a daily basis. These enabled the provider to gain feedback on the quality of service they provided and allowed them to determine where any changes could be made to improve outcomes for those who used the service.

Although people received the care and support they needed, records held in their files did not always reflect this. We looked at four people's files and found they had not always been kept up to date. Daily care plan checklist which staff used to indicate what care and support had been given in the morning, afternoon and evening had not always been fully completed. Similarly the daily logs kept in each person's file had not always been completed either.

We also noted poor recording procedures in relation to one person's behaviour which had been assessed as a risk to themselves and others. However the guidelines for staff to follow did not show what actions were to be taken to minimize such risks to others and staff, which had the potential to place people at harm.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to maintaining an accurate record in respect of each service user's health and support needs.

All the care workers we spoke with were confident in their role and told us they felt supported and listened to by management.