CARE HOMES FOR OLDER PEOPLE
Assessment and Rehabilitation Centre Assessment and Rehabilitation Centre Clifton Avenue Blackpool Lancashire FY4 4RF Lead Inspector
Mr Kevan Royston Unannounced Inspection 27th September 2006 09:30 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 Assessment and Rehabilitation Centre DS0000033553.V302262.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. 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. Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Assessment and Rehabilitation Centre Address Assessment and Rehabilitation Centre Clifton Avenue Blackpool Lancashire FY4 4RF 01253 477855 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) Blackpool Borough Council Judith Anne Buffham Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25), Physical disability (3) of places Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 25 service users to include Up to 25 service users in the category of OP (Older Persons over 65 years of age) Up to 3 service users over the age of 60 years in the category of PD (Adults with Physical Disabilities) 10/12/05. Date of last inspection Brief Description of the Service: The Assessment and Rehabilitation centre provides care and support for 25 older persons to enable people to live as independently as possible following a rehabilitation programme. The staff team consists of health and social work professionals to assess and rehabilitate persons over a period of approximately six weeks. The home consists of two floors with a passenger lift for access. There are lounges situated on both floors and treatment rooms with aids and adaptations to assist the staff to rehabilitate the residents. All the rooms are single occupancy with shared bathroom and toilet facilities on both floors in sufficient numbers to meet the needs of the residents. There is a dining area and spacious grounds to the front and rear of the building with seating available and wheelchair access. There is a statement of Purpose/Service user Guide, which is given to all prospective residents. This written information explains the care service that is offered, who the owners and staff are and what the resident can expect if he or she decides to stay at the home. There are no charges at the home as this is a Social Services Assessment and Rehabilitation Centre. Extra charges are made for hairdressing and personal items. Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 27th of September over a period of approximately 4.5 hours. The Inspector spoke to the manager of the day, four staff, health professionals employed at the home, three residents on there own and a group of residents in the lounge. As part of the inspection process the inspector used case tracking as a means of assessing some of the National Minimum Standards. The process allows the inspector to focus on a small number of people living at the home. All records relating to these persons are examined and the rooms they occupy are looked at. Other residents are invited to pass their opinions to the inspector if they wish. The response from surveys sent to relative’s and residents for there views on how the home is run was good, twenty completed questionnaires received from residents and two from relatives. Comments were positive about the standard of care provided, how the rehabilitation programme was operated and the support from staff and management. Records of a member of staff were also examined. A tour of the premises was undertaken. Examination of the homes documentation, policies and procedures formed the basis of the inspection process. What the service does well:
The staff team consists of health and social care professionals available at the home daily and supporting each resident on their individual programme ensuring they get expert care and support. One resident spoken to said, “Its definitely helped me and given me confidence when I go home”. Another resident said, “I wouldn’t have managed going straight home from hospital”. Due to the rehabilitation programme staffing levels at the home are high enabling more time to spend with each individual during their stay. An Occupational therapist employed at the home spoken to said, ”We are able to spend more time with residents because of the number of staff available”. Residents confirmed the support they receive from staff comments included “there is a lot of help available”. And, “The staff are able to help because there is enough of them”. Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 6 All twenty surveys returned from residents and two from relatives/carers for their comments on how the home is run and standard of care provided were positive confirming the support and care of residents is a priority and commitment of the staff to the rehabilitation programme. Comments included, “Food is good with a choice”. “No problems with the staff there are here to get us better”. Staff spoken to said, “Each member of staff plays their part to help the residents return home if possible and it works well”. What has improved since the last inspection? What they could do better:
Recruitment information with checks for suitability for staff must be available for inspection at the home to ensure the safety and protection of residents is maintained. Monthly reports provided by a representative of Social Services are required by regulations. These must be completed and sent to The Commission for Social Care Inspection (CSCI) to ensure that there is an external overview of the management of the home which can show any developments that are taking place and make sure the residents needs are being met. Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 7 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. Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The admission and assessment procedures were clear to ensure the needs of residents are met. Residents are assessed for intermediate care in order to rehabilitate to live an independent life as possible. EVIDENCE: Residents case tracked had full detailed accurate assessment information provided by health and social care professionals to ensure the suitability of individuals to complete the rehabilitation programme, and return to independent living. One staff member spoken to said, “The input of staff is important to determine each residents needs to develop a care plan for there stay”. One resident spoken to said, “Its very thorough when you come here they certainly give you confidence to manage”. The rehabilitation facilities observed are excellent and enough space for equipment and treatment to ensure residents mobility and confidence is provided. Staff spoken to said “We have good programmes and equipment to
Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 10 support people with mobility problems. One resident said halfway through the programme said, “It is helping me walk steadily”. Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Promotion of health is taken seriously. Resident’s welfare is closely monitored and health needs are identified and met. EVIDENCE: Records of three residents were examined and accurately reflected the individual’s health and social care needs. Care plans were up to date and regular reviews taking place every two weeks outlining any changing health needs required and how the individual is progressing through the programme. Reviews involve the resident and a multi disciplinary staff team of health and social care professionals. Residents spoken to said “ The programme is great and I know when we meet every two weeks how I am doing”. A staff member spoken to said, “Each input by staff helps the patient through the programme”. Records show risk assessments are recorded and reviewed to update any changes during the individuals programme. Medication practices observed were safe and good records had been kept ensuring residents health is maintained. The manager spoken to said, “Only
Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 12 staff that have had training administer medicines”. As a course of good practice residents photos are on their individual medication sheet to provide further safety and protection. The pharmacist visits weekly to check on medication issues and ensure correct procedures e followed. A member of staff spoken to said, “Its good the pharmacist visits weekly”. Records examined confirmed self medication forms had been signed by some residents enabling them to be responsible for there own medication needs. Observations of residents rooms showed personal belongings are allowed into the home despite only being there on a temporary basis to provide a homely atmosphere. One resident spoken to said, “I brought one or two bits in to make it like home”. The manager spoken said, “We could make provision for there own furniture to be fetched in if they wanted to”. Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 13 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): 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities and meals are both well managed, creative and provide daily variation and interest for people living in the home. EVIDENCE: Menus examined are balanced and interesting. Meal times are set although flexible enough to accommodate preferences. Resident spoken to and their comments from the returned surveys commented on the high quality of food at the centre. Comments included “The food is very good”. And, “Decent choices”. A tour of the kitchen area and discussion with the chef confirmed the cleanliness of the kitchen and use of fresh produce is a priority. The chef said, “I order the produce and like to use fresh fruit and vegetables as much as possible”. Records examined confirmed a need for special food for one resident and discussion with the chef demonstrated he had a good understanding of special diets for religious beliefs and diabetic needs. He said, “You have to be aware of peoples religion and health needs in relation to food”. The home has a separate kitchen area which residents can use to make snacks and drinks for themselves and visitors. And it is used as part of their rehabilitation programme.
Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 14 Residents spoken to confirmed visitors are allowed at any time of the day or night. One resident said, “They don’t mind what time my family come”. Examination of records confirmed activities are centred on residents choices and in accordance with their care plan which includes their daily exercise programme. This can sometimes limit the time for structured activities due to each individuals rehabilitation programme. Staff spoken to said, “We organise games and bingo”. Another said, “With a lot of staff we can sometimes go out on a one to one with the person”. The manager spoken to said, “We have better access to the mini bus now so trips out can be arranged”. Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 15 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): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for recording and reporting of complaints are good ensuring people feel listened to. The management team and staff have good knowledge and understanding of adult protection issues, which protect residents from abuse. EVIDENCE: The centre has a detailed complaints procedure, which is made available to all residents and relatives on admission and is included in the homes brochure ensuring the residents feel protected. Staff spoken to are aware of the complaint and abuse procedures. One member of staff said, “I did abuse issues on my NVQ (National Vocational Qualification) course. Comments from surveys from relatives and residents confirmed they know who to speak to should they wish to make a complaint. One resident spoken to said, “I would speak to Judith if I had a problem”. Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 16 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): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is safe and clean maintained to a good standard providing comfortable surroundings for the residents. EVIDENCE: A tour of the building found the home to be clean and tidy. The home is maintained to a good standard and examination of maintenance records showed there is a rolling programme of general repairs and renewal of the premises ensuring the comfort and safety of the residents is maintained. Observations of some areas of the home have been improved, with the decoration of some bedrooms and the outside garden decorated with furniture and plants to provide pleasant areas to relax in. One resident spoken to said, “The gardens are nice to sit in the good weather. A staff member said, “ staff have worked hard to create a lovely pleasant area for the residents”.
Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 17 There are policies and guidance for laundry processes and for the control of infection ensuring the home is kept clean, pleasant and hygienic. Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 18 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): 27,28,29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The procedures for the recruitment of staff are good safeguarding the residents. Records kept at the home of recruitment checks for staff are poor. Training for staff is very good ensuring they have the skills and competencies for their roles. EVIDENCE: Observation of duty rotas and discussion with staff confirmed there were more than sufficient numbers of staff on duty to ensure the resident’s needs are met. One member of staff spoken to said, “With each resident having a programme of rehabilitation extra staff are needed for support both care staff and health professionals”. A resident spoken to said, “Its nice having a lot of staff around the place”. Examination of two staff files and other staff records briefly looked at confirmed the recording procedures of the home are adequate. One staff file contained the documentation required by legislation and included, application form, individual photographs, CRB (Criminal records Bureau), POVA (Protection of Vulnerable Adults) checks and references. Other staff files looked at did not have all the documentation in place for inspection. Discussion with the manager confirmed checks have been completed however some of the documentation has been returned to Social Services (human resources) without copies kept at the home of documents required for inspection.
Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 19 Recruitment information with checks for suitability for staff must be available for inspection at the home to ensure the safety and protection of residents is maintained. Records show training is ongoing and the home now has over 50 of staff that has completed NVQ (National Vocational Qualification) level 2 in care to meet the recommendations of the National Minimum Standards and provide the staff with the necessary skills to carry out there role at the home. Staff spoken to commented on the excellent training opportunities provided. A staff member spoken to said, “I have completed my NVQ level 3 and I am really glad I have I feel it has helped me and given me confidence”. Another staff member said, “Training is always on offer here the manager is supportive for us to attend courses”. Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The centre is managed well and has systems in place for the protection of staff and residents. EVIDENCE: The registered manager has completed the necessary qualifications recommended by the National Minimum Standards in management and care and has the necessary competences and skills to manage and support the staff and residents. Comments from surveys returned by relatives and residents were positive in the way the home is run and managed. They included, “A good well organised programme it helps a lot of people”. And, “There is good management and you are always able to talk to them”. Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 21 Examination of records and information received from the manager confirmed regular tests to emergency lighting, fire procedures and extinguishers had been carried out ensuring the safety of residents and staff is maintained. Regulations require a visit monthly from an appointed person of the organisation and a report sent to CSCI (Commission for Social Care Inspection) to explain any developments and monitor the care provided to ensure the home is managed properly and continues to develop to provide the care and support for the residents and staff. This must take place monthly. Records show the management has good systems to gather staff, residents and relative’s views to enable ongoing improvements to the home. Regular staff meetings are recorded and suggestions are carried out if agreed by both parties. One staff member said, “We have regular meetings to give our views”. Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 22 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 4 X X 4 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 23 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 OP37 Regulation 17,26. Requirement Records required by the Regulations must be in place. Under Regulation 26, monthly unannounced visits to the home must be undertaken by the responsible individual and a report provided to CSCI. Recruitment documentation for staff required by legislation must be available at the home for inspection purposes. Timescale for action 30/11/06 2 OP29 19 schedule (2) 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Assessment and Rehabilitation Centre DS0000033553.V302262.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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