Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Simonsfield 1a Sunbury Road Liverpool Merseyside L4 2TS The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Garrity
Date: 3 0 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 28 Information about the care home
Name of care home: Address: Simonsfield 1a Sunbury Road Liverpool Merseyside L4 2TS 01512607918 01512600319 simonsfield@europeanwellcare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : European Wellcare Homes Ltd care home 36 Number of places (if applicable): Under 65 Over 65 36 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following category 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 within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 36 Date of last inspection Brief description of the care home Simonsfield is registered with us to provide personal care for 36 people with an age related condition. It is a purpose built care home with several sitting areas for people to socialise, sit quietly or entertain visitors and friends. A separate smoking lounge is provided. Bedrooms are located on all three floors in the home and there is a passenger lift that provides access to all the floors. There are gardens located at the rear and side of the home and large parking area at the front of the building. Simonsfield is located on a quiet residential road near to Stanley Park. There are bus stops within 10 minutes walk on a main bus route to and from Liverpool. Care Homes for Older People Page 4 of 28 Brief description of the care home The home is owned by European Wellcare Homes Ltd, which owns several homes that provide a variety of care and support to people living in them. The manager has worked in the home for several years and is registered with CSCI. The fees for the home from 330 pounds per week up to 518.11 pounds with an additional top up of appoximatley 15.45 pounds paid for by a third party (not the person living in the home or social services). Information about Simonsfield is availiable in the main office of the service and upon request. 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: The visit was carried out over a period of one day. We (the commission) arrived at the home at 10:30 and left at 18:30. We spoke with 12 people who live in the home, 1 visitor, 7 staff, deputy manager and the manager. We completed the inspection by a visit to Simonsfield, a review took place of many of the records available in the home and our offices. These included individuals care records, staff rota, staff files, maintenance records, menus, questionnaires, medications and information sent to us by Simonsfield. The service sent us self audit known as an AQAA, which contains information about how the service will increase its qulaity. This visit included discussions with people who live in the home, visitors, staff and management. Care Homes for Older People
Page 6 of 28 We also received information from Social Services and this information is included within this report. The arrangements for equality and diversity were discussed during the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the home used to determine individual needs, promote independence and support to make informed decisions in line with their choices. 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 set out 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 28 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. All people wishing to move into Simonsfield are assessed before they do so to make sure that the service can meet their needs. Information is available that helps people decide if Simonsfield is where they would like to live. Evidence: The AQAA for the service told us, We have revised the Pre-assessment (a review of peoples needs before they move in) document which now is more person centred. We carry out a pre-admission assessment on prospective clients before admission to the home ensuring that we can meet their needs. We looked at four peoples assessments, all had received the opportunity to have their needs reviewed before they moved into Simonsfield. Assessments now include more opportunity to look at peoples social needs and food choices. In some of the assessments looked at details were very brief and did not cover equality and diversity needs. The manager informed us that they are having difficulty in re-assessing people after they have been in
Care Homes for Older People Page 11 of 28 Evidence: hospital and this can impact on their ability to see if peoples needs have changed. We discussed the regulations and advised that staff need to know if they can meet peoples needs and this action needs to be included in services admissions process. We looked at the information available in the home, known as a statement of purpose (what services Simonsfield will provide) and service users guide (how these services are to be provided). These have been reviewed and now include information such as the criteria for admission into the service. A copy of both pieces of information was available in the main office. We spoke to people who live in the home some of whom recalled having received a copy of this information. We spoke to the manager who told us that they could obtain copies straight from the computer that were in large print. Copies that need translated into another language would take longer, but could be made availiable. 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. People living in Simonsfield have their healthcare needs meet. Evidence: People living in Simonsfield were supported to choose their own GP or stay with their previous GP. Records in general regarding healthcare were improved and described what actions the external professional had asked for. We spoke to the community matron (an external health care professional) who told us, I have no problems here, it is anything wrong to contact me straight away. This approach means that individuals health care needs are now addressed rapidly with appropriate advice and support put into place. Four care plans were looked at none of the care plans viewed had a signatures of individuals or their relatives that agreed to the care plan. People living in the home told us they had not seen their care plan for some time or did not recall seeing it at all. Staff spoken with did sometimes read the plans the majority relied on the verbal conversations. Staff spoken with found care plans of limited value in some cases
Care Homes for Older People Page 13 of 28 Evidence: information in the plans did not tell them what they needed to know. When we looked at the care plans we noticed that these documents were very confusing. In some cases people lived in the home had four different care plans stored in three different places. In two cases all four care plans gave different information. The manager told us this that they had undertaken a significant amount of work to write and update care plans. The amount of work was clearly evidenced however the approach that they had taken had resulted in confusing and conflicting information. In some instances this had led to the care plans are not being in date. An example included an individual who developed a chest infection. The service had contacted the district nurse and antibiotics had commenced. The course of antibiotics had been given to the individual, but there was no reference at all in the care plan to this need. Without accurate care plans that give clear instructions to staff individual support will not be consistent and runs the risk of not meeting their personal needs. Although peoples healthcare needs are being met and the management of the home are looking into improving care planning records, this remains an area that needs improvement to ensure that peoples care needs are set out in a effective plan. The AQAA for the service told us, New residents are given the choice of self medicating if they wish to do so. We looked at the recording of medicines and we found some improvements in the records of receipt, administration and disposal. Handwritten records were not always accurately completed and in some cases missed some of the label instructions necessary to staff. Records of external medicines and nutritional supplements were more detailed and showed that they were being given to individuals correctly. Information to care staff using creams, kitchen staff giving out supplementary foods were not available. Instructions to staff are necessary in order to make sure they give out the medications correctly. We looked at how medicines were checked and audited. Although paperwork and procedures were in place we found that they a discrepancy had been noted on the previous months audit that the manager and the deputy were unaware off. Having good audits that our actioned have helps ensure medicines are administered and recorded correctly. 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. People living in the home are offered meals that they enjoy. Evidence: All the people living in the home told us that they enjoyed the food provided. They told us that they enjoyed the food and there is always a choice. The cook asks people when they are admitted to the home what kind of things that they would like to eat. Information for the people living in the home to enable them to make choices is available, there are menus on each dining table. The menus do reflect a choice and people where seen to eat a variety of different food during the visit. The menus have been updated to show any special needs such as soft diet or diabetic diet. The cook has taken on-board responsibility for supplementary food, but has no written instructions for these. Staff members were weighing people on a regular basis and in most cases were aware if they were losing weight. Risk assessments were in place that had been looked at each month. It was noted that the risk assessments had not always been completed correctly or where issues were identified clear instructions were not always available. The manager discussed a new risk assessment known as MUST and how the service intended to put this in place to recognise and monitor
Care Homes for Older People Page 15 of 28 Evidence: peoples nutritional needs. There was an activities board, which had information on it . The board was poorly completed and was not readable, handwritten information wss illegiable. As such it did not provide suitable information for the people who live in the home. The service does not record how people would like to spend their time. Information of this nature was not detailed in the care records. Records were available that showed what group activities people had been involved in. There was little or no information as to how they would like to spend their individual time to maintain their independence and their personal interests. Good practice was noted with one individual being given small admin duties at their request and another assisting in the kitchen for small tasks again at their request. None of these activities that maintained their independence and give an individual sense of value were noted in the persons care plans. Without clear instructions to support staff they are relying on information that may be incorrect and therefore may make the wrong choices. Relatives are encouraged to visit the home and arrangements can be made for people living in the home to visit relatives and friends. 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. People who live in the home feel confident that their concerns will be listened to and acted on. Evidence: The AQAA for the service told us, We have a complaints procedure displayed in the foyer of the home. Policies and procedures of the home are followed and are available for all staff visitors, professionals and contractors.. We looked at the records regarding complaints. There have been two complaints and one major concern since the last visit. All complaints had records detailing what the concerns were. The manager had recorded all concerns even if told to her informally. This is good practice and help the service recognise and resolve any issues. People living in the service told us that they were confident that staff would fix any issues they had. There has been one concern that was sent by the home to social services, as it was serious in nature. We were informed that the service took appropriate action to make sure that this issue could not happen again. Staff have received training in recognising potential abuse. Staff discussed with us what they had understood from their training and were clear that they would report any concerns to the home manager. The homes policy and procedures in these areas are in need of updating in order to make sure that staff receive the correct guidance when serious incidents occur. Care Homes for Older People Page 17 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Several areas of Simonsfield have been redecorated and these make the home appear much cleaner and brighter. There remain some areas in need of redecoration and refurbishment. Evidence: The service has had a lot of redecoration over the last year, the corridors have been redecorated and pictures put into place. Some of the bedrooms have been redecorated. There are no firm plans in place that detail when the other areas of the home will be redecorated or replaced. This includes refurbishment of bathrooms, replacement of rotting windows as examples. Plans that would inform people of when they can expect their personal space to be redecorated would help maintain people who live in the services choices. Some maintenance issues are addressed quickly on the day of the visit one of the bedrooms doors had a faulty lock, the manager made sure that the maintenance person was aware of this and checked on progress during the day. The AQAA for the service told us that We have a maintenance book and any repairs are recorded. People living in the home thought it was much nicer and staff agreed that the appearance of the home had significantly improved. Care Homes for Older People Page 19 of 28 Evidence: On the day of the visit the weather was very warm, the service had opened its main front door and the door from the dining room to help reduce the heat. This had compromised the security of the service as it was very easy to access the building unchallenged. There were fans available but these were limited in number, none were in the dining room, two lounges or the smoking lounge. The manager had risk assessed the environment with regards to the heat wave and made sure that plenty of cold drinks were available. The service has three lounges, dinning room for people to use. There is an additional area that is used for people who smoke. People living in the service have their own bedrooms. When we looked at these several had personal items in place and equipment to help maintain independence such as fridges and kettles. People living in Simonsfield told us, I love my room and its my space, staff keep it clean for me and they are really good. When we looked around the home we noted that the majority of it was clean and presented nicely. There were different places in Simonsfield for people to spend their time. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The monitoring and development of staff training is not always sufficient to make sure that staff have the skills they need to support the people living in the home. Not all staff are recruited properly and checked that they are suitable before they start work. Evidence: The AQAA for the service told us that, All staff are undertaking all mandatory training and additional training. We have a float team that covers for staff sickness and holidays they also cover the European Care homes in Liverpool. Staff files have currently been revamped into a new format neater and are easier to understand. We looked at four staffing files. A recently recruited staff members file was viewed. This was better organised than those seen at previous visits. The individual had transferred from another home and did not have a copy of both references or a police check (CRB) on file. The manager was able to confirm during our visit that the individual did have a CRB but was unable to locate a second reference. Another member of staff had started working before they had received a CRB. This is acceptable provided that they receive a full induction, have all recruitment checks in place and do not work unsupervised. There was no evidence that this person had completed a full induction or that they worked supervised until their police check was received. All of the other files viewed were well organised and contained evidence that
Care Homes for Older People Page 21 of 28 Evidence: all members of staff had been properly checked before they were employed. Staff spoken with listed training that they have received and the majority have completed or are attending a training course in care (known as an NVQ), others have undertaken diabetes, others have done training in Alzheimers. However the home has individuals with a variety of needs including Parkinsons, epilepsy, dementia and behavioural needs. The manager had developed a training tracker that showed what training staff had and what they needed. This and staffing files showed that several staff still need to complete training including moving and handling training as an example. People who live in the home said that they thought staff are really nice. Staff spoken with said that morale had been very low for a time as there were so many changes in manager but they now have permanent manager and this had increased morale. Staff observed during the day were unhurried and relaxed in their approach. 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. A stable management team has helped improve the quality of the service in a number of areas. There remains issues with effective management of peoples personal allowances. Evidence: We discussed with the manager the progress of her application to be registered with us. There have been some administrative difficulties and the managers application had to be resubmitted with us. The manager told us she has applied for her CRB check with us and is anticipating submitting her application once she has received the CRB. The manager has been in post for nearly a year and this has helped her create a more stable service. Staff spoken with expressed confidence in the managers abilities and felt that a number of positive changes had occurred in Simonsfield. The AQAA submitted to us did not make clear what plans the service had to improve services or what actions had been taken from our last visit to meet requirements. The manager had addressed both requirements from the last report.
Care Homes for Older People Page 23 of 28 Evidence: There are a number of tools available in the home that looks at the quality of the service. These include questionnaires to people whom in the home and their families, auditing on key areas such as medications, staff training, care planning and safety. These have been done on a regular basis in some cases issues identified in these audits have not been passed to the management team to be actioned The organisation has contacted an external quality assurance scheme known as investors in people to review the quality of some areas of the service that they provide. In the past the organisation has had several meetings with us and had presented us with plan of how they will manage individual funds. This has not been fully activated as yet and there are still areas of confusion for all involved included people living in the service staff, managers and social services. It was agreed that people living in the service would received monthly statements when we looked at the statements available all were several months out of date. The manager explained that there is a small float of money available for people should they wish to access their funds. Larger amounts need to be ordered. A policy is in place in the service users guide. This is unclear as to how individuals funds will be managed. The service has no information available that informs the staff of how much people are entitled to and as such it is impossible for them to monitor that people are receiving the correct personal allowances. We looked at the arrangements for health and safety in the home including risk assessments. These had all been updated and changed as needed. The activities coordinator makes sure that all activities particularly those outside the home are fully planned. 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 7 15 People living in the home need an accurate care plan as to how their needs are to be met. The plan needs be kept under review, and individuals notified of any revision. All Plans need to be agreed by the people living in the service in order that their wishes are taken into account and provide clear instructions to staff about the support individuals choose. 31/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations 1 3 The service should consider including new legislation such as the mental capacity act as part of their assessment. In order to make sure that peoples full needs are determined and agreed too. All medications such as PRN, creams and supplementary
Page 26 of 28 2 9 Care Homes for Older People feeds need clear instructions availiable to the staff responsibile for giving out medications. 3 19 Develop a maintenace plan that informs the people who live in the service when they can anticipate changes, what the refurbishment and redecoration may be, how they can influence it and keeps staff up to date. Where audits identify practice issues these need to be recognised and appropriate action taken to resolve the issue. The service needs to keep clear information about peoples personal allowances. This should include their entitlement, better information on how their accounts are managed and up to date statements. 4 33 5 35 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!