CARE HOMES FOR OLDER PEOPLE
ANDREW SMITH HOUSE Marsden Hall Road North Nelson Lancashire BB8 8JN Lead Inspector
Marie Matthews Announced 19 July 2005
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. ANDREW SMITH HOUSE CS0000022506.V226354.R01.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Andrew Smith House Address Marsden Hall Road North Nelson Lancs BB8 8JN 01282 613585 01282 611630 julie.gaskell@btconnect.com Stocks Hall Care Homes Limited 50c White Moss Road Old Skelmersdale, Lancashire, WN8 8BL Mrs Julie Gaskell Care Home with Nursing (N) 40 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) Category(ies) of Physical disability (PD) - 30 both sex registration, with number Old age, not falling within any other category of places (OP) - 32 both sex Physical disability over 65 years of age (PD(E)) - 30 both sex ANDREW SMITH HOUSE CS0000022506.V226354.R01.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Within the overall registration of 40, a maximum of 32 service users who fall into the category OP 2. Within the overall registration of 40, a maximum of 30 service users who fall into the category of either PD or PD(E). 3. Staffing for service users requiring nursing care will be in accordance with the Notice issued dated 29th November 2000. Date of last inspection 24.10.04 Brief Description of the Service: Andrew Smith Care Home in Nelson is part of a group of homes owned by Stocks Hall Care Homes. It is a two-storey property with a lift to all floors and wheelchair access to all parts of the home. The home has 40 beds and is registered to provide both personal and nursing care for older people and younger adults with a physical disability. The home is located in Nelson across from a school and is close to the local park, community centre and shops. There is a bus service nearby and the home has a small car park. The outside of the home has patios and grassed areas, which are accessible to the residents and in summer, provide a popular sitting area. The home has a number of lounges and dining areas on both floors and there is a smoking lounge available on the second floor. There is a small conservatory at the side of the home and the entrance area is also a popular place for sitting and meeting visitors. The home has 40 single rooms some of which are en-suite; throughout the home are toilets, bathrooms and showers all of which have adaptations to assist the service users. ANDREW SMITH HOUSE CS0000022506.V226354.R01.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The announced inspection was conducted at Andrew Smith House on 19th July 2005. The inspection involved looking at records, talking to management, three staff, eleven residents and two visitors, a tour of the home and generally looking at what was happening in the home. Information was also taken from comment cards filled in by sixteen residents and fourteen visitors. This inspection looked at things that should have been done since the last visit and a number of areas that affect resident’s lives. The home had recently extended its facilities and was awaiting registration and inspection of the new building by the appropriate authorities. Once registered the home would provide a twelve-bed dementia unit, eight-bed younger disabled unit, seven-bed rehabilitation unit and thirty-three bedded unit for older people. Other improvements will include an activity, therapy, hairdressing and staff rooms. There were thirty people living in the home on the day of the visit. Residents and visitors were keen to praise staff and said they ‘ do their very best’, are ‘smashing’ and that ‘nothing is too much trouble for them’. What the service does well:
The home always completed thorough assessments and then confirmed whether they were able to meet resident’s needs prior to admission. Residents said they were treated well and felt ‘well cared for’ and that ‘it is a nice home’, the staff ‘are friendly and work very hard’. One resident said staff ‘respect me as a person’. Staff were observed speaking to people in a respectful but friendly manner. Residents said they were offered choices in many aspects of their lives at the home and felt they were involved in decisions. The home offered a varied programme of either group or individual activities that met people’s needs and expectations. The home also had use of a minibus for various outings. The home had a good complaints system with evidence that people felt their views were listened to and acted upon. One resident said ‘Julie (the registered manager) always wants to know if anything is wrong so that she can sort it out’. Visitors said concerns ‘are always taken seriously’. The home was comfortable, safe, accessible and well maintained. All rooms were bright and airy. Residents and their visitors commented on how clean the home was. Resident’s said their rooms were ‘very nice’ and had ‘lots of space’. The grounds were tidy and accessible and garden furniture was available for people to use. ANDREW SMITH HOUSE CS0000022506.V226354.R01.doc Version 1.30 Page 6 The home had a thorough recruitment procedure and this protected residents from unsuitable staff. Training records showed staff had been provided with appropriate training to assist them to meet the needs of the residents in their care. What has improved since the last inspection? What they could do better: 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. ANDREW SMITH HOUSE CS0000022506.V226354.R01.doc Version 1.30 Page 7 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 ANDREW SMITH HOUSE CS0000022506.V226354.R01.doc Version 1.30 Page 8 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) 1, 2, 3, 4 and 6. Residents and prospective residents were given detailed information about the services the home provided. This enabled them to make informed decisions about whether the home could meet their needs. The home always completed detailed assessments and confirmed whether they were able to meet resident’s needs prior to admission. EVIDENCE: The statement of purpose and service user guide had been reviewed and provided detailed information about the home. The unit providing rehabilitation short stay beds had a separate service user guide. Residents said they had copies of the guide in their rooms and some had read them. Resident’s views of the home needed to be included. All residents were given a contract on admission. Three care files were looked at. Care plans had been generated from detailed assessments. One resident said the registered manager had visited them prior to admission. The home had confirmed, in writing, they were able to meet the resident’s needs prior to admission.
ANDREW SMITH HOUSE CS0000022506.V226354.R01.doc Version 1.30 Page 9 Training files showed staff received appropriate training and support to ensure they could meet the needs of the residents who lived at the home. The home had a separate unit that provided care for short stay residents who required rehabilitation before returning home. This unit had separate facilities. Care was given by staff who had been appropriately trained and were supported by qualified physiotherapists and occupational therapists. ANDREW SMITH HOUSE CS0000022506.V226354.R01.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 and 10. The care planning system was clear and detailed and provided staff with the information needed to meet resident’s needs. Residents and relatives were involved in decisions about their care. EVIDENCE: Three care plans were looked at. These had been developed from initial assessment information. A new system had been introduced and the care plans were clear, detailed and organised and showed how staff would meet resident’s needs and expectations. Various assessments had been included and staff had taken appropriate action when a risk had been identified. There was evidence that residents or their relatives had been involved in the development and monthly review and update of their plan. One relative said she was aware of the care plan following recent meetings. Eleven visitors said they felt they were consulted about their relatives care and three did not. Two visitors said they had to ‘find and ask staff’ for information. Medication was not assessed at this visit as policies and procedures were under review. Residents said they were treated well and felt ‘well cared for’. Six residents said they ‘sometimes’ liked living at the home and ten liked living at the home.
ANDREW SMITH HOUSE CS0000022506.V226354.R01.doc Version 1.30 Page 11 Residents said that ‘it is a nice home’, the staff ‘are friendly and work very hard’ and one resident said staff ‘respect me as a person’. Staff were seen knocking on doors and speaking to people in a respectful but friendly manner. ANDREW SMITH HOUSE CS0000022506.V226354.R01.doc Version 1.30 Page 12 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, 14 and 15. The home offered residents a varied programme of activities that met their needs and expectations. The home provided a varied and nutritious menu and tried hard, in consultation with residents, to try to meet individual tastes. EVIDENCE: Residents said they were able to make choices about many aspects of their day. This included meals, activities and daily routines. The activity co-ordinator had displayed a programme of activities on the notice board. Thirteen residents said the activities were ‘suitable’, two said ‘sometimes suitable’ and one said ‘not suitable’. A group of residents and their relatives were participating in a quiz on the afternoon of the inspection. Outings had been planned for the warmer weather. Residents said they could choose whether to join in or not. Visitors said they were able to visit at any time and felt welcomed into the home. The menu was displayed around the home and residents confirmed they were offered a choice of meal. One resident said if they didn’t like the available choice a further alternative would be offered. The menu always offered a
ANDREW SMITH HOUSE CS0000022506.V226354.R01.doc Version 1.30 Page 13 choice of meal. The meals offered were varied and nutritious. On the day of inspection the meals were nicely presented. A lighter meal was offered at lunchtime with a more substantial meal at teatime. There were varied opinions about the food. The comment card information indicated that nine residents ‘sometimes’ liked the food and seven indicated they ‘always’ liked the food. One resident said there was ‘not enough fresh fruit and vegetables’. Visitors made comment about the presentation and poor nutritional value of food and poor quality fillings in the sandwiches. Seven residents said they generally enjoyed the food. The registered manager was aware of these concerns and the menu had been reviewed with the cook following meetings with the residents and visitors. Discussion had also taken place with other homes in the group. Consideration was being given to consulting with a dietician. The registered manager said she would continue to consult with residents and their visitors on this issue. Residents were pleased with the newly refurbished dining room. Dining tables were attractively set. ANDREW SMITH HOUSE CS0000022506.V226354.R01.doc Version 1.30 Page 14 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. The home had a good complaints system with some evidence that people felt their views were listened to and acted upon. EVIDENCE: A record of concerns and complaints had been maintained. Residents and visitors were aware of whom to raise concerns with. One resident said ‘Julie (the registered manager) always wants to know if anything is wrong so that she can sort it out’. Visitors said concerns ‘are always taken seriously’. ANDREW SMITH HOUSE CS0000022506.V226354.R01.doc Version 1.30 Page 15 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, 24 and 26. The standard of the environment within this home was good and provided residents with a clean, safe, comfortable and attractive place to live. EVIDENCE: The home was clean, safe, accessible and well maintained. Residents and their visitors commented on how clean the home was. Resident’s rooms were bright, airy and comfortably furnished and personal items had been brought in to add to the ‘homely’ feel of the home. All resident’s rooms had a lockable storage space and a lock to the room door. Resident’s said the rooms were ‘very nice’ and had ‘lots of space’. The carpet in the smokers lounge was damaged by cigarettes and was due to be replaced. Residents were very pleased with the refurbished dining room and said it was bright and a ‘very pleasant room to eat in’. It was clear from a tour of the home that maintenance and renewals were ongoing. The grounds were tidy and accessible and garden furniture had been provided. Residents said they had enjoyed sitting in the gardens during the fine weather.
ANDREW SMITH HOUSE CS0000022506.V226354.R01.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 and 30. The home was working hard to address staffing problems caused by a period of instability that had impacted on the consistency of care. Staff morale had improved and staff were positive and enthusiastic. The residents were protected by the home’s thorough recruitment procedures. The home gave staff appropriate training to ensure they were able to meet the needs of the people in their care. EVIDENCE: The rota showed the home was staffed to levels required by the previous authorities staffing notice and there was evidence that efforts had been made to cover any shifts when staff had rung in sick. However both residents and visitors expressed concerns about the numbers of staff on duty and comments were made about residents having to wait for attention at times. One resident said ‘I sometimes have to wait a long time before staff can help me’. Seven of the eleven comment cards said they didn’t feel there were enough staff on duty at times. People felt staff did not have enough time to sit and chat and ‘do the little things’ with residents. Some visitors were concerned about the turn over off staff and the effect this was having on staff morale. The registered manager was responding to the concerns and said that the staff team was now more stable. Staff also said that a number of staff had left but the new team worked well together and morale was much better. The home was currently reviewing staffing levels in preparation for when the new units open. It was required that staffing levels kept under review to ensure residents needs could be met at all times.
ANDREW SMITH HOUSE CS0000022506.V226354.R01.doc Version 1.30 Page 17 Residents and visitors were keen to praise staff and said they ‘ do their very best’, are ‘smashing’ and that ‘nothing is too much trouble for them’. Two staff files were looked at. Both files contained the required employment checks to meet regulation. It was recommended that copies of the Protection of Vulnerable Adults and Criminal Records Bureau checks, that are currently maintained at head office, are available for inspection. Training records showed staff had been provided with appropriate training to assist them to meet the needs of the residents in their care. The home was committed to training staff to NVQ level 2 and 3. All new and existing staff completed a comprehensive package of ‘mandatory’ training. ANDREW SMITH HOUSE CS0000022506.V226354.R01.doc Version 1.30 Page 18 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, 32, 33 and 36. The home regularly reviewed aspects of its performance through a programme of self-review and consultation; these included seeking the views of residents, staff and visitors to the home. The staff team and people who lived at the home benefited from the good leadership and management of the home. EVIDENCE: The registered manager is Mrs Julie Gaskell. She has experience in both the NHS and private sector. Mrs Gaskell is due to commence an NVQ 5 in Management to enable the home to meet the criteria of this standard. Residents and visitors to the home were aware of Mrs Gaskell’s responsibilities. One resident said ‘she wants us to be happy’ another said ‘if I tell her she will sort it out’. Residents and visitors said they attended regular meetings, had completed surveys and generally felt they were kept informed. The results of the recent survey had been made available. A survey was sent to people such
ANDREW SMITH HOUSE CS0000022506.V226354.R01.doc Version 1.30 Page 19 as GPs, physiotherapists and occupational therapists; the results were held on file. Staff attended regular meetings and felt they were able to have their say. Evidence that staff were supervised was seen on file. Staff spoke positively about changes that Mrs Gaskell had made and said the home was ‘a much nicer place for everyone’. One member of staff described her as ‘quietly strong’. ANDREW SMITH HOUSE CS0000022506.V226354.R01.doc Version 1.30 Page 20 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 2 3 3 3 x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x 3 x 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 2 3 3 x x 3 x x ANDREW SMITH HOUSE CS0000022506.V226354.R01.doc Version 1.30 Page 21 no 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 27 Regulation 18 Requirement The registered person must ensure that staffing numbers are appropriate to meet the needs of the residents at all times. Timescale for action By 1/9/05 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. 2. 3. 4. Refer to Standard 1 28 29 31 Good Practice Recommendations Residents views should be included in the service user guide. A minimum of 50 of care staff should have an NVQ in care (level 2 or equivalent) Copies of POVA and CRB checks should be stored on staff files in the home. The registered manager should have an appropriate management qualification. ANDREW SMITH HOUSE CS0000022506.V226354.R01.doc Version 1.30 Page 22 Commission for Social Care Inspection 1st Floor, Unit 4, Petre Road, Clayton Business Park, Accrington, Lancashire, BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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