CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE
Andrew Smith House Marsden Hall Road North Nelson Lancashire BB8 8JN Lead Inspector
Mrs Marie Matthews Key Unannounced Inspection 9th October 2007 09:30 X10029.doc Version 1.40 Page 1 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 Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 2 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 and Care Homes for Adults 18 – 65*. 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 DS0000022506.V352967.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Andrew Smith House Address Marsden Hall Road North Nelson Lancashire BB8 8JN 01282 613585 01282 611630 julie.gaskell@btconnect.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Stocks Hall Care Homes Limited Care Home 60 Category(ies) of Dementia (12), Dementia - over 65 years of age registration, with number (12), Old age, not falling within any other of places category (40), Physical disability (20) Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 60 service users to include: A maximum of 40 service users in the category of OP (older people) A maximum of 20 service users in the category of PD (physical disability under 65 years of age). A maximum of 12 service users in the category of either DE (Dementia) or DE(E) (Dementia over 65 years of age) Date of last inspection 20th February 2007 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 is registered to provide both nursing and personal care for up to sixty people in four separate units; providing a twelve-bed dementia unit, eight-bed younger disabled unit, seven-bed rehabilitation unit and a thirtythree bedded unit for older people. 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 that are accessible to the residents and their visitors. The home has a number of lounges and dining areas on both floors. The home offers single rooms some of which are en-suite; throughout the home are toilets, bathrooms and showers all of which have adaptations to assist the residents. Information about the services that the home offers is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their relatives. The fees range from £342.50 to £705.50. Additional charges are made for hairdressing, personal toiletries, podiatrist, massage, newspapers and some outings.
Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The key unannounced inspection, including a visit to the home, was conducted on 9th October 2007. The inspection involved looking at records, talking to the registered provider, manager, five staff, one visitor and five residents in detail and a tour of the premises and generally looking at what was happening in the home. The manager had provided written information about the home prior to the inspection and information was also gathered from survey forms completed by four visitors, four residents and two visiting professionals. An expert by experience accompanied the inspector on the visit. An expert by experience is a person, who because of their experience and ability to communicate with people visits a service with the inspector to help them to get a picture of what it is like to live in or use the service. The expert by experience was involved to help the inspector determine whether people’s social needs and expectations were being met. Aspects of his findings were included in the report. This inspection looked at things that should have been done since the last visit and a number of areas that affect resident’s lives. There were fifty-nine residents living in the home on the day of the inspection. What the service does well:
People were given the information they needed to help them to decide whether Andrew Smith House was a suitable place for them to stay. New residents were not admitted to the home until a full care needs assessment had been undertaken by a senior member of staff; this was to make sure their needs would be met. All residents had a care plan that contained useful information about how their needs were to be met. The care plans focused on the individual’s needs, strengths and personal preferences. There was evidence that resident’s health was monitored and appropriate action taken if health needs changed. One visitor commented ‘they do their best to see to all my mothers needs. Her pain and medication are under control’. Medication procedures provided staff with safe guidance to manage resident’s medicines properly and safely.
Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 6 Staff respected resident’s dignity and rights to privacy and all staff had received customer care training to help them to respond to people appropriately. Residents confirmed they were able to make choices and decisions about how to spend their day. Two activity co-ordinators were employed to work with residents in groups and on a one to one basis; records showed there had been a range of varied activities, excursions and entertainments that were suitable and appropriate for the individuals in the home. The menus offered a choice of meal at each sitting and records showed alternatives to the menu had been provided to meet resident’s dietary needs. The manager advised that a nutritionist had been consulted when developing menus to ensure meals were well balanced, nutritional and catered for residents varied cultural and dietary needs. The expert by experience said ‘there are three substantial meals served throughout the day, the residents choosing which main meal suits them best’ and ‘the food was hot and substantial and we were asked if we wanted extra sausages’. One resident said ‘the food here is always good’. The complaints procedure was clear and had been made available to residents and their visitors; people knew how to make a complaint and were sure their concerns would be responded to appropriately. The expert by experience made a point of asking a number of staff, residents and their visitors if they were aware of the procedures to follow in the cases of abuse or complaints they all replied in the affirmative; this means that staff know the importance of taking the views of residents seriously, and of listening to and responding to raised issues. The adult protection procedure was clear and provided safe guidance for management and staff. Training of staff in the area of protection had been provided to give them the knowledge to recognise and respond to any reports or suspicions of abuse. From a tour of the premises it was clear that the environment was homely, safe, accessible and had been designed to meet residents individual needs. It was clean and very well maintained and had good access to community facilities and services. One resident said his room was well equipped and another said ‘this is more than I could have hoped for’. Gardens were well maintained, safe and accessible to residents and their visitors; one resident commented on the ‘lovely view of the gardens’ from her bedroom window. Survey information showed that people thought staff were skilled and experienced. Records showed that all staff received a range of training to help them to meet the diverse needs of residents in their care. Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 7 Records showed that a safe recruitment procedure had been followed; this would help to protect residents from being cared for by unsuitable people. Comments from residents and their visitors were very positive about staff and included ‘staff are friendly and wiling to help’, ‘they are always friendly and welcoming and my relative tells me they are her friends’, ‘staff are kind to the residents and helpful and friendly to relatives’ and ‘I have no worries when I go home as I know she is being well cared for 24 hrs a day’. The views and opinions of residents and their families had been sought to ensure their needs and expectations were being met; there was evidence that management had responded to any issues raised to improve the service. Records showed people’s health, safety and welfare were protected and that staff were trained in health and safety matters. What has improved since the last inspection? What they could do better:
Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 8 It was suggested that additional information should be recorded in the care plan regarding residents past history and employment, particularly for those residents on the ‘dementia’ unit, as this would help staff to respond to residents needs on a more individualised basis. Staff must ensure that any risks to residents and staff are regularly assessed and any action to reduce or remove the risk should be clearly recorded in the care plan to guide staff. Staff had not consistently followed medication procedures regarding checking prescriptions prior to dispensing and witnessing handwritten charts; failure to follow these procedures could result in errors being made. Residents had not been involved in the interview and selection process although the manager said this would be considered in the future. 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. The summary of this inspection report can be made available in other formats on request. Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. People were given the information they needed to help them to choose a home that would meet their needs. Detailed assessments were always completed and confirmation was given, in writing, that their needs would be met. EVIDENCE: Each unit had their own service user guide and copies were provided in resident’s rooms. The guide included clear information about the specialist services provided at Andrew Smith House; there was also a newsletter that gave people additional information about available services and activities. Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 11 Surveys indicated that people were given enough information Andrew Smith House prior to admission. Four residents records were looked at in detail. It was clear that new residents were not admitted to the home until a full needs assessment had been undertaken by a senior member of staff. Letters confirming that their needs would be met were then sent. Records supported that staff received appropriate training to help them to meet the diverse needs of the residents in their care. There was a separate unit for residents who needed rehabilitation before going home. The unit has specialised facilities and equipment and suitably qualified staff to help residents increase their independence and to return home safely. One visiting professional said it was ‘an excellent rehabilitation unit’. Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents received health and personal care that was based on their individual needs. The principles of respect, dignity and privacy were put into practice. Medication policies and procedures provided safe guidance although staff had not always followed guidance which could put residents at risk. EVIDENCE:
Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 13 Four care plans were looked at in detail. The care plans had been developed from the initial assessment information and focused on the individual’s needs, strengths and personal preferences. There was evidence in the records and from survey information to support that residents or their representatives had been involved in decisions about care. One visitor was asked about the care plan for her relative and she said ‘I signed it on her behalf’ another said ‘they go through her care package with me regularly’. The care plans had been reviewed regularly and updated to reflect current care needs. All residents had been allocated key workers who would provide one to one support and develop a closer relationship with them and their visitors. It was suggested that additional information should be recorded in the care plan regarding residents past history and employment, particularly for those residents on the ‘dementia’ unit, as this would help staff to respond to residents needs on a more individualised basis. The care plans included assessments of any risks to resident’s safety and these had been generally reviewed on a regular basis to ensure the information was up to date. However one resident’s records indicated that their behaviour posed a risk to others; this had not been risk assessment and there was no guidance to support staff in the care plan. On another care plan it was unclear how often risk assessment need to be reviewed and this was not consistent with the written procedures. Any limitations on freedom, choice or facilities were discussed with the residents or their representatives, were made in the residents’ best interests and were recorded and reviewed on a regular basis. There was evidence that resident’s health was monitored and appropriate action taken if health needs changed. Records showed that health professionals had visited when necessary and residents had access to healthcare facilities in the local community. Residents confirmed they were able to see their GP in the privacy of their own rooms. One visitor commented ‘they do their best to see to all my mothers needs. Her pain and medication are under control’. Staff said they had received training on health care topics that related to the specific health care needs of the residents. Residents were provided with a range of aids and equipment to maintain their comfort, safety and independence. Specialist advice had been sought to ensure effective use of equipment. Medication procedures were in place to provide staff with safe guidance however staff had not consistently followed the procedures regarding checking prescriptions prior to dispensing and witnessing handwritten charts. This was discussed with the manager and a meeting was arranged to discuss some of the issues with the community pharmacist. All other aspects of the Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 14 management of medicines were in line with safe procedures and maintained residents safety. From discussion with residents and observation it was clear that staff respected peoples dignity and rights to privacy. All staff had received customer care training to help them to respond to people appropriately; staff were seen talking to residents and visitors in a polite but friendly manner. Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. A range of suitable age related activities that met individual’s diverse social, cultural and recreational needs and expectations were provided. Residents were provided with a choice of wholesome and nutritious meals that met their dietary requirements. Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 16 EVIDENCE: The expert by experience was involved to help to determine whether residents social needs and expectations were met. Residents confirmed they were able to make choices and decisions about how to spend their day. The home employed two activity co-ordinators to work across the units; records showed that activities were varied, appropriate for the differing ages and included one to one and group activities. On the day of the visit the Activity Co-ordinators were observed playing carpet skittles with a number of residents who appeared to enjoy the experience. Outings are organised using the company’s minibus for shopping trips, swimming trips, theatre outings and tours of Blackpool Illuminations; one resident was due to go on holiday next month and said she was looking forward to the trip. A grant had been obtained and would be used to set up a “Sensory Activities Room” which would benefit residents on all units and help them to relax; a computer had been provided on one of the units and would enable residents to use their laptops independently. The hairdresser, local clergy and a chiropodist visit regularly and medical, dental and optician services are also catered for. Newspapers and magazines were provided and could be ordered for delivery to individual residents; residents were kept up to date with recent activities and events by the home’s newsletter. Residents confirmed that they could have visitors at any reasonable time and that they were able to visit in any area of the home. Cordless phones and a payphone were available so that residents could maintain contact with their friends and relatives. The expert by experience talked to a visitor who said there were no restrictions placed on visitors; he said ‘one to whom I spoke was full of praise for the staff, saying “The staff here are really good”’. The kitchen was clean and the dining areas were bright and tables attractively set to enhance the dining experience. The menus offered a choice of meal at each sitting and records showed alternatives to the menu had been provided to meet resident’s dietary needs. The manager advised that a nutritionist had been consulted when developing menus to ensure meals were well balanced, nutritional and catered for residents varied cultural and dietary needs. Residents made positive comments regarding the food and said they were always offered a choice. Resident’s dietary preferences were ascertained on admission and the cook was informed of these; there was evidence that special diets were catered for and that the cook had consulted with residents and relatives to ensure their specific dietary needs were met. The expert by experience said ‘there are three substantial meals served throughout the day, the residents choosing which main meal suits them best’. Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 17 The expert by experience had lunch with the residents he said ‘The food was hot and substantial and we were asked if we wanted extra sausages’. One resident said ‘the food here is always good’. Staff gave discreet support to residents who needed extra assistance and the mealtime was relaxed to give residents the time they needed to finish their meal comfortably. Satellite kitchens were available on each unit to enable residents and their visitors to make their own snacks and drinks. Some residents said they had enjoyed preparing their own snacks and had participated in baking sessions. Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 18 Complaints and Protection
The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. People were able to express their concerns and had access to an effective complaints procedure. Residents were protected from abuse and had their rights protected. EVIDENCE: The complaints procedure was clear and had been made available to residents and their visitors. Records showed that any concerns and complaints had been responded to according to the procedure. From discussion with residents and their relatives and from survey information it was clear that people knew how to make a complaint and were sure their concerns would be responded to appropriately. The expert by experience made a point of asking a number of staff, residents and their visitors if they were aware of the procedures to follow in the cases of abuse or complaints they all replied in the affirmative; this means that staff know the importance of taking the views of residents seriously, and of listening to and responding to raised issues.
Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 19 Complaints were monitored each month and action had been taken to improve the service. The adult protection procedure was clear and provided safe guidance for management and staff. An incident had occurred recently and management had followed procedures to ensure residents were safe from harm; this supported that management was clear about the local Safeguarding procedures and had been involved in open discussion with external bodies. Training of staff in the area of protection had been provided to give them the knowledge to recognise and respond to any reports or suspicions of abuse. Training to support staff in dealing with physical and verbal aggression was also available. Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 20 Environment
The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Residents lived in a safe, comfortable and well-maintained environment that met their individual needs and expectations. Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 21 EVIDENCE: From a tour of the premises it was clear that the environment was homely, safe, accessible and had been designed to meet residents individual needs. It was clean and very well maintained and had good access to community facilities and services. A programme of maintenance and renewal was produced that showed ongoing improvements to the home. There was a full time handyman employed and request for repairs were responded to promptly. One survey form returned by a relative had included some suggestions for improvements to the younger disabled unit such as wheelchair height mirrors, easy close drawers and lowered hanging rails for clothing these were discussed with the manager and unit manager at the time of the inspection. Gardens were well maintained, safe and accessible to residents and their visitors; one resident commented on the ‘lovely view of the gardens’ from her bedroom window. Recent improvements to the garden areas provided residents with a greenhouse and garden shed and raised flowerbeds accessible to wheelchair users. Aids and adaptations were provided to meet resident’s needs and to assist with mobility and to promote independence. Bedrooms were bright, clean and comfortably furnished; residents had brought in personal items to enhance the homely feel. All rooms were single occupancy, had lockable storage and locks to the door to maintain residents privacy. One resident said his room was well equipped and another said ‘this is more than I could have hoped for’. All rooms were provided with call leads for when residents needed to call for assistance; these had been removed on one of the units for appropriate reasons. Residents were offered a key to their own room unless a risk assessment indicated otherwise. There was a selection of communal areas both inside and outside of the home where residents could choose a place to sit quietly, meet with family and friends or be involved with other residents. The bathrooms included aids and adaptations to meet resident’s needs with sufficient toilets for those rooms without en suite facilities. The home was well lit, clean and tidy and smelled fresh. Residents and their visitors commented that the home always smelled fresh and clean. Additional laundry equipment and extra laundry staff had been provided following concerns raised at the last key inspection; laundry areas were clean, organised and well equipped. One visitor said ‘mum’s laundry is done regularly, returned to her room and put away’. Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Residents were protected by a robust recruitment procedure and staff in the home were trained, skilled and provided in sufficient numbers to meet residents needs. EVIDENCE: There were no concerns regarding staffing levels and staffing had been increased on one of the units and in the laundry following a number of concerns raised during the last key inspection. Residents said there were always staff to help and one resident said ‘ I only have to press the buzzer and staff are there to help me’. One visitor said ‘I see the same staff so there is some continuity of care’. Records showed there was a wide diversity in the staff team that reflected the culture and gender of residents using the service. Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 23 Three staff recruitment files were looked at in detail. Records showed that a safe procedure that would protect residents had been followed. Residents were not as yet involved in the interview and selection process although the manager said this would be considered in the future. Survey information showed that people thought staff were skilled and experienced. Records showed that more than half of care staff had an appropriate qualification in care and all staff received a range of training to help them to meet the diverse needs of residents in their care. Staff spoken to said that the provision of training was excellent; one staff member said ‘we get loads of training’. Comments from residents and their visitors were very positive about staff and included ‘staff are friendly and wiling to help’, ‘they are always friendly and welcoming and my relative tells me they are her friends’, ‘staff are kind to the residents and helpful and friendly to relatives’ and ‘I have no worries when I go home as I know she is being well cared for 24 hrs a day’. Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 24 Management and Administration
The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. The views and opinions of residents and their families had been sought to ensure their needs and expectations were being met. People’s health, safety and welfare were protected by the management practices.
Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 25 EVIDENCE: Mrs Janine Kelly has been in post as manager for approximately six weeks and had been supported through a period of induction by the previous manager. Mrs Kelly has the required qualifications and experience and is highly competent to run the home. An application pack to register her with the Commission for Social Care Inspection is being completed and Mrs Kelly is due to undertake management training to assist her with her role. Suitably qualified and competent unit managers assist her to maintain good standards of care for residents and their relatives. People’s views have been sought about whether their needs and expectations are being met. Annual satisfaction surveys had been completed for each unit and the results had been made available; there was evidence that management had responded to any issues raised to improve the service. Regular meetings with staff, residents and their relatives were held and minutes were recorded; staff said they were able to contribute their ideas and that management ‘listened’ and were ‘very supportive’. The service had achieved the Investors In People award; this is an external quality assurance system that helped management to identify areas of strengths and weaknesses. Regular audits of medication, care and finances had been introduced and the manager said they were to be further developed to improve this aspect. All aspects of the day-to-day management of the home were monitored every month; this ensured standards are maintained and that people’s needs and expectations were being met. The home has a comprehensive range of policies and procedures to promote and protect residents’ and employees’ health and safety and these are kept under review. There were systems that ensured effective safeguarding and management of resident’s money including clear and accurate record keeping. The records of two residents were checked and found to be accurate. Staff confirmed they were supervised and supported by senior staff; this ensured staff have the skills and competency to meet the needs of the residents in their care. Records showed people’s health, safety and welfare were protected and that staff were trained in health and safety matters. Accidents were reported and
Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 26 recorded appropriately and action had been taken to reduce any risk of harm to residents, staff and visitors to the home. Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 27 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 Standard No Score 1 3 2 X 3 3 4 4 5 X 6 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 4 ENVIRONMENT Standard No Score 19 4 20 3 21 3 22 4 23 X 24 3 25 3 26 3 STAFFING Standard No Score 27 3 28 4 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 4 34 X 35 3 36 3 37 X 38 3 Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 28 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 OP8 Regulation 13 Requirement Any risks to residents must be fully assessed and interventions recorded in the care plan and kept under regular review. Timescale for action 19/11/07 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. 5. Refer to Standard OP7 OP9 OP9 OP29 OP31 Good Practice Recommendations Care plans should include detailed information about resident’s social history and preferences. Staff should check the prescriptions prior to medicines being dispensed. Handwritten prescriptions on medication administration charts should be witnessed. Consideration should be given to involving residents in the recruitment and selection process. The manager should be registered with the Commission for Social Care Inspection and achieve a recognised management qualification. Andrew Smith House DS0000022506.V352967.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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