CARE HOMES FOR OLDER PEOPLE
Ann Slade Care Home, The 5 Mornington Road Southport Merseyside PR9 0TS Lead Inspector
Mrs Margaret Van Schaick Unannounced Inspection 30th January 2006 09:45 X10015.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 Ann Slade Care Home, The DS0000005316.V281465.R01.S.doc Version 5.1 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. 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. Ann Slade Care Home, The DS0000005316.V281465.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Ann Slade Care Home, The Address 5 Mornington Road Southport Merseyside PR9 0TS 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) 01704 535875 01704 512917 Brooklyn Home Limited Mr Korwin-Granford Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Ann Slade Care Home, The DS0000005316.V281465.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 24 OP Date of last inspection 14th September 2005 Brief Description of the Service: Ann Slade is a residential care home that specialises in the care of older people. The home is registered for 24 service users and is owned and managed by Mr Korwin-Granford who has many years experience in the care of older persons. Ann Slade is located within a suburb of Southport and is close to all local amenities. The home presents an older type property, which has been converted into a care home with the accommodation being provided over three floors all served by a passenger lift. The communal space within the home consists of one dining room 2 lounge areas and a small smokers lounge. All communal space is provided on the ground floor. The home has 22 single and one double bedroom all having en suite facility. The home provides limited car parking to the front of the premises. The home provides ramped access to all entrance and exit areas and has aids and adaptations in place to meet all assessed need. Ann Slade Care Home, The DS0000005316.V281465.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over two days and lasted 7.15 hours. This was the second unannounced inspection carried out this year as part of the regulatory requirement for care homes to be inspected at least twice a year. As part of the inspection process some areas of the home were viewed including residents bedrooms. Care records and other nursing home records were inspected as part of the process. Discussion took place with the Manager, Deputy Manager, financial administrator and one to one interviews with two of the care staff. Several residents were also spoken with. Three of the residents were interviewed on a one to one basis and their views of the home obtained. During the inspection visit care staff were observed to be courteous and supportive in their manner towards residents. What the service does well:
Residents are able to make decisions about how they wish to live their lives with support from their families, relatives and staff where needed. One of the residents interviewed stated “I do my laundry myself” and other comments include “I am able to continue using my car when I want to”. Other residents interviewed come and go when they wish to, just letting the staff know when they are going out. Through discussion with staff employed in the home it is apparent that they are aware of the need to be alert to the possibility of abuse and their understanding ensures residents in their care are protected where possible. Residents’ comments include “I’m very happy living here, it’s a very nice place and staff are very good, excellent in every way”. The home is clean with comments from residents including “my bedroom is very clean and “my room is cleaned always”. Systems are in place to ensure records are kept to evidence monitoring of temperatures of food storage therefore this promotes the welfare of the residents in the home. The homes Provider/Registered Manager attends mandatory training, has just completed the Registered Managers Award and is in day-to-day control of the home. Staff interviewed commented that “they were happy to approach
Ann Slade Care Home, The DS0000005316.V281465.R01.S.doc Version 5.1 Page 6 management in the home and find the home has a lovely friendly atmosphere”. 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. Ann Slade Care Home, The DS0000005316.V281465.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Ann Slade Care Home, The DS0000005316.V281465.R01.S.doc Version 5.1 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 the following standard(s): Standard 3 was assessed and met at the last inspection and standard 6 is not applicable. EVIDENCE: Ann Slade Care Home, The DS0000005316.V281465.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 9,11 Further pharmaceutical training for the staff that administer medications needs to be sought to ensure all medication prescribed is administered as prescribed. EVIDENCE: One resident is at present self-medicating and a signed agreement is in place. The deputy Manager confirms that the resident concerned is capable of selfmedicating. A suitable lockable space to store medication needs to be in place in the resident’s bedroom. The resident also arranges all the ordering and receipt of medication and a record of prescribed medication is in place. The home needs to ensure the resident keeps them informed of any changes to their prescription. All other medication entering the home has full records in place with regard to ordering, receipt, disposal and administration of medication. Creams prescribed by GP’s are documented. Staff responsible for the administration of medication has attended training and further updated training has been arranged for this year via the homes pharmacist. A list of staff signatures and initials is in place. Medication fridge temperatures are not recorded daily therefore this needs to commence with a daily record kept. The home has set
Ann Slade Care Home, The DS0000005316.V281465.R01.S.doc Version 5.1 Page 10 up a new policy for new residents admitted through the hospital to ensure the correct medication is given and sufficient medication is made available. This is good practice. The home carries out a daily audit of Temazepam, which is good practice. On occasions the District Nurse may administer suppositories or enemas therefore this needs to be documented on the Aberdeen (medication) sheets and dated. Discussion took place with the deputy Manager with regard to the administration and recording of prescribed Didronel/Cacit. To ensure it is administered as prescribed the medication needs to be clearly identified and recorded on the Aberdeen’s; dependent on whether Cacit or Didronal is administered to save any confusion. One other resident at present has some GTN (Glyceryl Trinitrate) patches and it is believed that they are administering them when they feel like it instead of the usual daily dose. The deputy Manager has been advised to contact the GP urgently to find out if the resident is prescribed them or not. Since the inspection visit the deputy Manager has informed the Commission that the resident has now been prescribed an alternative oral medication, which will be administered by staff. The deputy Manager has arranged a review of medication for one other resident who is refusing the prescribed medication on a regular basis. This is good practice. Most of the staff employed at the home has attended courses arranged by the local hospice with regard to care of the dying. Further training is being looked at for staff to attend this year. Following discussion with staff it is apparent that they are able to support the resident and their families at this difficult time with additional support provided through McMillan Nurses where necessary. Following discussion with staff it is apparent that they are also aware of their limitations in this area. Ann Slade Care Home, The DS0000005316.V281465.R01.S.doc Version 5.1 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 the following standard(s): 14,15 Residents are able to make decisions about how they wish to live their lives with support from their families, relatives and staff where needed. EVIDENCE: Residents interviewed agreed that they are able to make decisions themselves about how they wish to live their lives with the help or support of their families or staff where needed. Comments from residents include “I don’t need to see the GP, nothing for him to come for, but I have my eyes checked at the optician and Jenny (deputy Manager) sorts this for me”. One resident stated “we have regular residents meetings with Jenny (deputy Manager), about once a month, the last one was the 20th January, I find it useful, if you don’t like anything or anything else you can say, but there is nothing to grumble about”. One other resident commented “they showed me to my room and I was able to change to another as I found the first room too noisy, too much going on”. One resident has the use of their own car and is able at present to use it whenever they wish to go out. A four weekly menu is in place and it offers a varied and nutritious diet with two main courses on offer each lunchtime and choice of puddings and a choice
Ann Slade Care Home, The DS0000005316.V281465.R01.S.doc Version 5.1 Page 12 of three main courses at teatime and choice of puddings. Residents interviewed confirmed that the choice of meals is available each day and all food served was enjoyed. Comments from the residents include “the food is very good, there is enough choice and enough food to eat” and “the food is very good and I’m putting on weight”. Most of the residents have their meals in the dining room or the dining area of the sitting room. One of the residents prefers all their meals in their own room as confirmed during interviews. Ann Slade Care Home, The DS0000005316.V281465.R01.S.doc Version 5.1 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 the following standard(s): 18 The staff employed in the home understands the need to be alert to the possibility of abuse and their understanding ensures residents in their care are protected where possible. EVIDENCE: Policies and procedures including a whistle blowing policy are in place. Staff interviewed showed an understanding of the varying forms of abuse that may occur and were knowledgeable about the process of alerting others to ensure the protection of the residents in the home. Staff have attended training with regard to elderly abuse and were brought up to date with POVA (Protection of Vulnerable Adults) in May 2005 as evidenced during staff interviews. Financial records are kept of all transactions and residents’ signatures evidence receipt of personal allowance. Ann Slade Care Home, The DS0000005316.V281465.R01.S.doc Version 5.1 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 the following standard(s): 26 The home is clean and systems are in place to ensure records are kept to evidence monitoring of temperatures of food storage therefore this promotes the welfare of the residents in the home. EVIDENCE: The home has a permanent external contracted domestic who is employed to maintain the homes cleanliness during a five-day week. Residents interviewed are pleased with the cleanliness of the public areas and their bedrooms. Comments from the residents include “my room is cleaned always, and I keep it tidy”, “my bedroom is very clean” and “there is no problems with the laundry”. The home was noted to be clean during the day of the unannounced inspection. The kitchen is in a clean state and records are kept of the cook monitoring daily temperature checks of fridges, freezers and hot food checks. Food stored in the fridge was covered and dated. The laundry floor needs resurfacing and the steps into the laundry are very worn and needs repair. The large stainless steel sink needs to have paint stains removed.
Ann Slade Care Home, The DS0000005316.V281465.R01.S.doc Version 5.1 Page 15 Ann Slade Care Home, The DS0000005316.V281465.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed this time as they were all assessed and met at the last inspection. EVIDENCE: Ann Slade Care Home, The DS0000005316.V281465.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,35 The homes Provider/Registered Manager attends mandatory training and has just completed the Registered Managers Award therefore this qualifies him for this position by training and experience. EVIDENCE: The Registered Manager/Provider has many years experience of managing the Care Home. He has also completed Level 4 NVQ (Registered Managers Award) and is just awaiting confirmation of his qualification. The Manager also attends mandatory and other training to update his knowledge and ensure the home is meeting the needs of the residents. The residents interviewed were very complimentary about the Registered Manager and deputy Manager. Comments from residents included “Edward (Manager) and Jenny (deputy Manager) are excellent” and “I can speak to Jenny if I’m worried about anything”. Staff interviewed were confident that if they had any concerns they could talk to the Manager or his deputy if needed.
Ann Slade Care Home, The DS0000005316.V281465.R01.S.doc Version 5.1 Page 18 The home does not hold any bank accounts or monies on behalf on the residents. All residents have individual financial records evidencing personal allowances are received with residents signatures kept. Residents who need financial support receive it from their relatives where needed. Ann Slade Care Home, The DS0000005316.V281465.R01.S.doc Version 5.1 Page 19 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X X Ann Slade Care Home, The DS0000005316.V281465.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13 (2) Requirement The Registered Person must ensure all medication prescribed by the GP is administered according to instructions in particular with regard to Didronel/Cacit and GTN patches as discussed. The Registered Person must ensure all staff trained to administer medication attend appropriate training and are assessed regularly to ensure they have a basic knowledge of how medicines are used and how to recognise and deal with problems. Staff must monitor the condition of the resident on medication and call in their GP if staff are concerned about any change in condition that may be a result of medication prescribed. The Registered Person must ensure a record is kept of all suppositories/enemas given by the District Nurse. Timescale for action 20/02/06 2 OP9 13 (2) 20/02/06 3 OP9 13 (2) 20/02/06 Ann Slade Care Home, The DS0000005316.V281465.R01.S.doc Version 5.1 Page 21 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 Refer to Standard OP9 OP9 Good Practice Recommendations The Inspector strongly recommends that the temperature of the medication fridge is measured daily and records kept. The Inspector strongly recommends that the resident who orders and receives their own medication is advised to inform senior staff of any changes that may occur to their prescribed medication. The Inspector strongly recommends that all residents who self medicate have a suitable, lockable cabinet to store their medication. 3 OP9 Ann Slade Care Home, The DS0000005316.V281465.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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