CARE HOMES FOR OLDER PEOPLE
Washington Grange Burnhope Road Barmston Washington NE38 8HZ Lead Inspector
Elsie Allnutt Unannounced Thursday, 5 May 2005 : 09.30
th 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 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Washington Grange DB52-B02 S54917 Washington Grange V220812 Stage 4 050505.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Washington Grange Address Burnhope Road, Barmston, Washington NE38 8HZ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0191 419 1955 0191 417 0100 Barchester Healthcare Ms Lynda Errington PC care home only 40 Category(ies) of 21 x Dementia - over 65; 19 x Old Age registration, with number of places Washington Grange DB52-B02 S54917 Washington Grange V220812 Stage 4 050505.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 21st December 2004 Brief Description of the Service: Washington Grange owned by Barchester Healthcare Limited is a purpose-built care home situated on the edge of the Barmston housing estate in Washington. The home is close to a local health centre, pharmacy and a social club. A short walk to the nearest bus stop provides access to the Galleries shopping centre and all its amenities, Sunderland City centre and to other parts of the surrounding areas. The home is a two-storey building offering single bedrooms with en-suite facilities that are easily accessed by a passenger lift and stairways. There are 19 bedrooms for older people on the ground floor and 21 bedrooms for older people with dementia care needs on the first floor. There is a range of bathrooms and showers, WCs, lounges and dining rooms on both floors. All parts of the building are easily accessible. Washington Grange DB52-B02 S54917 Washington Grange V220812 Stage 4 050505.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 7.5 hours. The view of service users and relatives were sought during the inspection and their overall view found was that the care and support provided in the home was satisfactory. Many of the service users made complimentary comments about the staff and their attitudes. They said; “they are kind,” “lovely people,” “they will do anything.” The relatives spoken to commented that they had no complaints and were happy with the service provided. A tour of the building was made as well as an examination of a number of records. Six of the ten staff on duty during the day, ten of the thirty-six service users and two visitors were spoken to and a midday meal was taken with service users. What the service does well: What has improved since the last inspection?
Due to the manager operating more effectively improvements have been made to the home. There is now a more appropriate number of staff on duty which means that more time is given to caring for service users. So that the staff
Washington Grange DB52-B02 S54917 Washington Grange V220812 Stage 4 050505.doc Version 1.30 Page 6 have the skills and know how to carry out their jobs effectively the home has provided them with various training courses. So that service users are protected from abusive situations staff have attended a training course that describes how to deal with such situations and the people that must be contacted. The care plans that describe how the service users’ needs are to be met have been improved and now include plans to reduce any risks that might be involved. The support of service users using the Dementia Care Unit has been improved as a result of; staff attending training in relation to dementia care, which includes training related to the handling of verbal and physical aggression, and an extra member of staff being allocated to work in the unit specifically to develop a “Memory Lane” project. So that staff are supported in their care roles the manager and deputy manager have plans in the near future to attend training in supervision skills. This will improve the care performance of individual staff and give them individual supervision sessions on a regular basis. Copies of the home’s Complaints Procedure have now been placed in the entrance hall some in large print so that service users and their families can easily access them. The identified “dimly lit passage ways” recorded in the last inspection report have now been improved by the replacement of new globe ceiling lights. This has improved this area in appearance and in relation to the safety of the service users. What they could do better:
So that the care plans include all necessary information related to service users needs improvements can be made to ensure that all relevant information from the preadmission documents is transferred to the current care plans. Although risk assessments and management plans are now included in the care plans these need to be further developed so that they cover all aspects of care including the medical needs of individual service users. Although it has been recognised that the needs of the service users in the Dementia Unit have been addressed in relation to activity, ongoing staff support must be improved in relation to addressing service users needs generally in this unit, and in particular during and approaching meal times. So that service users do not become bored and are offered the choice of a variety of activities the home should consider filling the vacant activity coordinators post.
Washington Grange DB52-B02 S54917 Washington Grange V220812 Stage 4 050505.doc Version 1.30 Page 7 The health and safety of the service users could also be further improved. The manager must address the issues brought to her attention in relation to making safe the potential tripping hazard in the hallway, and the removal of the obstacles in one of the fire exits, to which Immediate Requirement notices were served. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Washington Grange DB52-B02 S54917 Washington Grange V220812 Stage 4 050505.doc Version 1.30 Page 8 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection Washington Grange DB52-B02 S54917 Washington Grange V220812 Stage 4 050505.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,4 Service users are admitted to the home only after a comprehensive preadmission assessment. However not all the information is currently being transferred to the home’s care plans therefore service users full needs are not being addressed. EVIDENCE: All of the care files sampled included preadmission assessments and care plans carried out by the social worker and the home. In discussion with two service users they confirmed that their needs were addressed adequately. One of the care files examined did not include all of the information included in the social worker’s assessment carried out prior to admission and in relation to the person’s physical and emotional needs. This was discussed with the manager who agreed to address it so that service users’ needs are fully met. Washington Grange DB52-B02 S54917 Washington Grange V220812 Stage 4 050505.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 Generally the healthcare needs of the service users are met, but improvements can be made to ensure that all needs and risks, identified in the assessments, are included in the care plan. EVIDENCE: As an example of good practice a risk assessment was in place in relation to the number of falls experienced by one service user and so further advice could be sought through a referral to the Falls Specialist. However there was no care plan or risk assessments in relation to the needs of a recently admitted service user with Parkinson’s Disease and failing sight, neither were the emotional needs addressed. So that individual service users full needs are met this must be addressed. The manager explained how the home is now addressing the needs of the service users with dementia care. This information was confirmed by staff who spoke about the training they have received and the way there awareness in relation to dementia care had been raised. However there was there evidence of specialist intervention that may have been involved in the development of the care plan in relation to service users’ dementia care needs. In relation to medical issues care staff need professional guidelines to follow in order to be consistent with the delivery of care to be carried out.
Washington Grange DB52-B02 S54917 Washington Grange V220812 Stage 4 050505.doc Version 1.30 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12.13,15 Arrangements were in place in the dementia care unit to promote the health and well being of service users through improved meaningful activities. However through the absence of an activity coordinator this is not replicated throughout the home. Service users are offered a choice of meals, to help promote their health and general well being. EVIDENCE: The manager explained that in addition to the present allocated number of staff, the Company has recently appointed a member of staff with specific responsibilities and experience to work 3 days a week in the Dementia Care Unit. Their specific responsibility is to coordinate a “memory lane” project designed to involve people with dementia in meaningful activity using reminiscence as the main theme. Staff explained that this was in the initial stages of development and there were plans to develop a reminiscence room, a rummage box and 3 D photo boxes that would be placed outside service users rooms so that there door/room would be easily identifiable. It is also planned for families to be involved in this project by collecting photographs and other personal materials.
Washington Grange DB52-B02 S54917 Washington Grange V220812 Stage 4 050505.doc Version 1.30 Page 12 Service users in the main body of the home positively commented in relation to the variety and good quality meals that are provided, however showed their disappointment in relation to the lack of planned activities due to the absence of an Activities Coordinator. Washington Grange DB52-B02 S54917 Washington Grange V220812 Stage 4 050505.doc Version 1.30 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home takes complaints and concerns seriously and their procedures are accessible to service users and their relatives. Service users are further protected by the home’s Protection of Vulnerable Adults (POVA) procedures. EVIDENCE: Records examined demonstrated that staff have attended training, which is currently on going, in relation to the local authority’s procedures on the Protection of Vulnerable Adults. A copy of the procedures was evident in the home and staff were able to refer appropriately to them. Since the last inspection the home has made the Complaints Procedure more accessible to service users and their relatives. Staff explained that a copy is given and explained to all new service users on admission, and is available in the home’s foyer both in normal and large print. Two complaints made over the past 6 months were recorded in the Complaints Book and demonstrated that the procedures had been appropriately followed. When asked service users demonstrated that they knew what to do if they had a concern or complaint. Washington Grange DB52-B02 S54917 Washington Grange V220812 Stage 4 050505.doc Version 1.30 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,25,26 So that the quality of the original high standards of the environment is maintained, and the service users enjoy comfortable and safe surroundings that promotes their dignity and self esteem, the home is in need of redecorating and refurbishment. EVIDENCE: Staff, both care and ancillary, confirmed that they had recently attended training in relation to infection control. The areas of the home inspected were clean, tidy and generally well maintained. However as found at the last inspection the original high standard of décor and furnishings is now showing signs of wear and tear. The manager confirmed that the plans to refurbish the home throughout are to commence in the near future. A discussion took place with the manager in relation to the planned décor for the dementia care unit. It was suggested that specialist advice be sought in relation to the most beneficial colours and designs to use for people with dementia care needs, also how best the signage, used for orientation purposes, might be blended in with the new décor. The manager agreed to consider this.
Washington Grange DB52-B02 S54917 Washington Grange V220812 Stage 4 050505.doc Version 1.30 Page 15 The health and safety issues relating to the tripping hazard in the hallway and the obstacles in the fire exit must also be addressed. Washington Grange DB52-B02 S54917 Washington Grange V220812 Stage 4 050505.doc Version 1.30 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 Staffing levels are inadequate therefore service users needs are not fully met. EVIDENCE: The manager explained that since the last inspection the home has reviewed the staffing ratios and a support worker with particular responsibilities in the Dementia Care Unit has been employed for three days a week. Records and staff confirmed that the minimum staffing ratios are maintained throughout the home and there is a minimum of five staff on duty at all times. However when observing activity in the Dementia Care Unit during the teatime period it was evident that the needs of the service users could not be effectively met by two members, this being the number on duty at the time. In discussion the manager agreed that the staffing ratios and the allocation of staff in the home must be reviewed. The manager explained that a supernumerary member of staff had been employed to cover sickness and holidays. However this post was currently vacant but the manager emphasised that there were plans to re-advertise the post. So that the current minimum ratio of staff is maintained this is strongly recommended. Staff records confirmed that the home follows the Company’s comprehensive recruitment policies. One of the files examined was that of a member of staff who recently commenced work at the home and all appropriate records were in place including 2 references and an enhanced CRB check. Washington Grange DB52-B02 S54917 Washington Grange V220812 Stage 4 050505.doc Version 1.30 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,36&38 Service users are cared for in an environment where the manager’s performance in running the home is improving. EVIDENCE: Discussions with the manager and observations made concluded that she is well supported in her role by senior staff, ancillary staff and the home’s administrator. She is currently building up a network of contacts in other homes and with other dementia care agencies who support her and offer advice in the development of the service. The manager discussed the progress of her training related to her role that includes The Registered Managers Award and NVQ 4 in Care. Washington Grange DB52-B02 S54917 Washington Grange V220812 Stage 4 050505.doc Version 1.30 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 x 15 3
COMPLAINTS AND PROTECTION 2 x x x x x 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x x x x 2 x 2 Washington Grange DB52-B02 S54917 Washington Grange V220812 Stage 4 050505.doc Version 1.30 Page 19 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3,4 & 7 Regulation 15 Requirement Care plans must be include; all relevant information included in the preadmission documentation, and information related to individual medical conditions with the addition of guidelines for staff to follow in relation to these. Risk assessments and risk management plans in relation to medical conditions must be developed further and be an integral part of the care plan. Service users must be given the opportunity for stimulation through leisure and recreational activity. The health and safety issues relating to the frayed carpet in the hallway and the equipment creating an obstacle in the fire exit must be addressed. So that the needs of the service users are effectively met the staffing ratios and the allocation of staff in the home must be reviewed. A minimum ratio of 50 of care staff trained to NVQ 2 must be achieved by the end of 2005. The manager must also have Timescale for action 30.06.05 2. 8 13(4) 30.06.05 3. 12 & 13 16 30.06.05 4. 19 & 38 23(4)(b)& 12(1) Immediate 5. 27 18(1)(a) 29.07.05 6. 28 & 31 18(1) 30.12.05 Washington Grange DB52-B02 S54917 Washington Grange V220812 Stage 4 050505.doc Version 1.30 Page 20 7. 36 18(2) achieved the Registered Managers Award and NVQ 4 by this date. The manager must ensure that staff receive planned, formal supervision at least 6 times a year covering all aspects of practice, the philosophy of the home and career development needs. ( Timescale of 30.11.04 not met.) 29.07.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 2 Good Practice Recommendations So that the full needs of the service user that are assessed prior to admission are addressed, care should be taken to transfer all appropriate information from the preadmission documents into the current care plan. So that all service users are offered a variety of meaningful activities and retain contact with the local community it is strongly recommended that an Activity Coordinator is employed. It is strongly recommended that the planned refurbishment and redecoration programme is started as soon as possible, and that advice is sought in relation to colour schemes for the Dementia Care Unit. 2. 12&13 3. 19 4. Washington Grange DB52-B02 S54917 Washington Grange V220812 Stage 4 050505.doc Version 1.30 Page 21 Commission for Social Care Inspection Baltic House Port of Tyne South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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