CARE HOMES FOR OLDER PEOPLE
Atlantis Polperro Road Polperro Cornwall PL13 2JE Lead Inspector
Elaine Bruce Key Unannounced Inspection 30th January 2007 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 Atlantis DS0000008956.V322924.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. Atlantis DS0000008956.V322924.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Atlantis Address Polperro Road Polperro Cornwall PL13 2JE 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) 01503 272243 01503 273061 Mr Steven Paul Brailey Mrs Catherine Brailey Care Home 20 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (10), Old age, not falling within any other category (10) Atlantis DS0000008956.V322924.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th November 2005 Brief Description of the Service: Atlantis provides care for twenty older people, ten of whom can be admitted to the home with a dementia or mental disorder. Communal accommodation for the service users with a dementia and or a mental disorder is in a separate locked facility. Atlantis is a large detached house, part of which is a more recent extension. It stands in its own large grounds consisting of lawned areas, orchard with views over the surrounding countryside and distant sea views. Parking is available in the grounds of the home. Garden furniture offering seating and table facilities is available on the level patio area outside the front entrance and the garden is accessible to service users by the way of slopes and steps. Accommodation is provided on two floors which are connected by stairs and a stair lift. There are sixteen single rooms with six of these being en-suite and two double rooms having en suite facilities. Day care, respite care and meals on wheels are provided within the home, collecting and returning service users to their home for day care. There are three communal lounge areas, one of which can also be used to dine within and one of which is a sun lounge. There is a separate dining room but service users are able to exercise choice and can choose to eat in their own private room. Atlantis DS0000008956.V322924.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 took place on the 30th January 2007 over 7 hours and was carried out as an unannounced inspection. Service users spoken to during the course of the inspection expressed positive comments on the kindness of the staff at the home and the good standard of meals being provided. Prior to the inspection two service user comment cards were received at the CSCI. Both of these cards indicate satisfaction with the standard of care at the home. In addition three relatives/visitors cards were received again expressing complete satisfaction with “kind, caring staff” but two suggesting that “social interaction and stimulation” could be improved. These comments are assessed in the main body of the report. In addition to the comment cards a completed pre inspection questionnaire was received prior to the inspection. During the course of the day case tracking took place with four service users. One of the registered providers was present during the course of the inspection as was one of the senior management team. The home is divided into two distinct communal areas depending on the assessed dependency levels of the service users. The more frail service users with mental health needs are cared for as a group in an area of the home that is secured for safety. The range of weekly fees at the home is from £380 to £420. In addition to long and short stay care the home provide a day care facility on each day of the week and week end. What the service does well:
The management team are committed to having a trained work force and statutory and good practice training is regularly provided. Atlantis DS0000008956.V322924.R01.S.doc Version 5.2 Page 6 A staff member spoken to during the course of the inspection expressed very positive comments on the training that is presently taking place. It is noted that all staff to include cleaning and kitchen staff are included in training. The management structure is noted to be working well. There are four family members in the management team each with specific duties and responsibilities. The “family” are committed to delivering a good standard of care in a homely environment. 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. The summary of this inspection report can be made available in other formats on request. Atlantis DS0000008956.V322924.R01.S.doc Version 5.2 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 Atlantis DS0000008956.V322924.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s statement of purpose and service user guide documentation as well as a brochure provide prospective service users with details of what the home provides helping an informed decision about admission to the home. The registered provider assesses all service users prior to admission to the home to ensure that the home will be able to meet their care needs. EVIDENCE: The home has a service user guide and statement of purpose in place that meets the requirements of legislation. This documentation has recently been reviewed. A service user guide is available for each service user and all potential service user admissions to the home. In addition to the service user guide a brochure is provided. The service user guide states that service users
Atlantis DS0000008956.V322924.R01.S.doc Version 5.2 Page 9 have a right to receive an anti-discriminatory service which is responsive to their race, religion, culture, language, gender, sexuality, disability and age. The home has in place an admission policy and procedure to guide staff on good practice. Each service user has had an assessment of care needs undertaken prior to admission usually by the registered provider or one of the senior management team. Two senior care staff are also being trained to undertake these duties. Admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective service user. Where an admission takes place by the funding authority their assessment documentation is obtained. The majority of the admissions to the home are already known to the service as they have attended the home for day care. Atlantis DS0000008956.V322924.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. 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 this service. The service user’s health, personal and social care needs are being met by the staff and multidisciplinary staff as required. Medication is being administered correctly to the service users. Service users spoken to during the course of the inspection expressed positive comments on the kindness of the staff. EVIDENCE: Full and comprehensive individual plans of care are in place for each service user. The service user and their representative are involved in care planning. Evidence is in place of regular monthly reviews of care planning taking place and where appropriate care plans are then updated. It is recommended that
Atlantis DS0000008956.V322924.R01.S.doc Version 5.2 Page 11 where this is taking place staff sign and date when the care plan has been changed. It is noted that consideration has been given to including a life history on each service user. Each service user has a risk assessment in place that pays particular attention to the risk of fall frequency. All care staff are involved in recording. Daily night and day records support the care plans. This documentation is completed well. Care planning clearly evidences the health care needs of the service users and how these are being met. Evidence is available of visits and conversations with external professionals. Dental and optician services are provided in the home or locally if required. Chiropody services are available monthly in the home. Service users are weighed monthly and a discussion took place with the management team on using a recognised nutritional screening tool for preventative good practice. The management team have agreed to gather further information on this. A medication policy and procedure is available in the home to guide staff on good practice. All senior staff who have responsibility for medication administration have received accredited training. Medication administration records were found to be completed appropriately on the day of the inspection. An inspection of the medication arrangements has recently taken place by the pharmacy who supplies the home. All was found to be satisfactory from this inspection. Service users who have the capacity are encouraged to keep and take their own medication. Service users spoken to during the course of the inspection expressed very positive comments on the kindness of the staff in the home. The service users are happy with the way that the staff deliver their care and respect their dignity. Atlantis DS0000008956.V322924.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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. More activities and opportunities are planned for the social care needs of the service users to be met. The meals provided in the home are good with special diets catered for. EVIDENCE: The social care needs of the service users are identified through a detailed life history which the staff have spent a considerable time completing. Care plans and daily records include information on social care needs. In addition a record of social activities is kept which evidences group and individual activities. The inspection report of the 15th November recommended that a review of the social care needs of the service users took place. This has been undertaken and there are plans for new activities to be offered at the home. This was
Atlantis DS0000008956.V322924.R01.S.doc Version 5.2 Page 13 discussed along side the comments from two relatives that there could be more “a little more interaction between staff and clients” and “the service users would benefit from more one to one mental stimulation”. It is anticipated that new activities will offer more stimulation and one to one time. There are also plans for a summer fete to take place. Visitors are welcome to the home and entries are in place when the service users have received a visitor. All visitors are asked to sign in to the home when they arrive and guidance is displayed on visiting times. Normal visiting is encouraged between 0930 and 2000. Outside these hours visiting can be arranged with prior notice. The service users can receive their visitors in their own room or in one of the lounges. The home encourages service users to maintain all forms of social contact that they enjoyed before moving into the home. The hairdresser visits the home regularly. Arrangements are in place to meet any individual religious needs of the service users. The menu at the home rotates over a four week period. On the day of the inspection the main meal of the day was lasagne and garlic with an alternative menu of omelette. The cook has information on all the likes and dislikes of the service users. The main meal of the day is served at 12.30. The service users eat in two areas of the home depending on their dependency levels. These areas are staffed accordingly to provide help with eating as required. The staff presented as aware of the importance of feeding at the pace of the service user, making them feel comfortable and unhurried. The cook has recently attended a good practice swallowing and food workshop. In his absence there is another cook employed by the home. The home has recently taken on new systems in recording in relation to “Making food Safely”. All service users spoken to during the course of the day expressed very positive comments on the standard of the meals at the home. Atlantis DS0000008956.V322924.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. 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 home has a satisfactory complaints procedure provided to the service user in the service user guide. The home has in place adult protection policy and procedures to provide staff with the knowledge and understanding of adult protection issues and to protect service users from abuse. EVIDENCE: The home has an up to date complaints policy and procedure in place and each service user and their representative has received this documentation in their service user guide. The home is aware of the importance of good recording in regard to any concerns/complaints that they receive. The home has in place adult protection policy and procedures. Documentation guidance is also available on whistle blowing. It is recommended that updated information be obtained from the Adult Social Care Department on their good
Atlantis DS0000008956.V322924.R01.S.doc Version 5.2 Page 15 practice adult protection guidance. The staff are guided to the importance of adult protection policies and procedures in their job description. All staff have completed questionnaires to assess their level of understanding of adult protection. These are then assessed and a training certificate issued when staff have reached a satisfactory level of competency. Service users state that they are very satisfied with the service provision around their level of safety. Atlantis DS0000008956.V322924.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. 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. Service users live in a safe, comfortable and well maintained environment that is suitable for it’s stated purpose. EVIDENCE: Atlantis is situated a short drive from Polperro. The home is positioned in spacious grounds that are well maintained and accessible to the service users. Car parking is available at the home. Internally and externally the home is well maintained. Communal areas consist of two lounges although the lounge areas are divided depending on the assessed needs of the service users. One part of the home is therefore secure
Atlantis DS0000008956.V322924.R01.S.doc Version 5.2 Page 17 for safety reasons with key pads on the doors. Aids and equipment to meet the needs of the service users are in place as required. Bedrooms are individual and homely and available on the first and second floor of the home. There is a stair lift to access the first floor of the home should this be required. The home was found to be very clean on the day of the inspection. Cleaning staff are employed every day of the week. It is noted that they have time allocated to them to spend with the service users during the course of their duties. The home has recently purchased domestic machines to deal with the requirements of the laundry at the home. Care staff have responsibility for these duties. They have suitable equipment provided and policies and procedures are in place for infection control. Atlantis DS0000008956.V322924.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are appropriate to meet the needs of the service users. Staff training is very much encouraged and delivered by the management team. Recruitment procedures are satisfactory. EVIDENCE: On the day of the inspection four care staff were on duty in addition to the management team, the cleaner and the cook. The home employs two waking night staff. The recruitment procedures for new staff were found to be satisfactory on the day of the inspection. As discussed at the time of the inspection it is appropriate to update the criminal records bureau checks on some of the longer standing employees. Equal opportunities policy and procedures are in place for recruitment. It is noted that a number of the staff are long-standing employees adding to the stability of the care delivery. There is little use of any agency or temporary staff.
Atlantis DS0000008956.V322924.R01.S.doc Version 5.2 Page 19 Staff are encouraged to undertake regular training and training is highly regarded by the management team and staff. At this time 62 of the care staff have an NVQ 2 in care with more undertaking these studies. The service clearly defines the roles and responsibilities of staff through accurate job descriptions and specifications. Statutory training to include fire prevention, moving and handling is all up to date. All the staff are trained in first aid. Good practice training has recently included coping with aggression, dementia and parkinsons disease. Plans are in hand to improve the induction training new staff receive in line with the Skills for Council good practice guidance. Atlantis DS0000008956.V322924.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Atlantis is run by a management team that are all family members each with specific roles and responsibilities. The team are committed to delivery of a good standard of care and comments from service users confirm that this aim is met. EVIDENCE: One of the registered providers is a first level nurse and an NVQ assessor and verifier. She has nearly completed her registered managers award qualification. Both the registered providers are very involved in the running of
Atlantis DS0000008956.V322924.R01.S.doc Version 5.2 Page 21 the home to include working alongside staff members (hands on) as and when required. The registered providers are supported in their duties by two senior management staff members who are family members. There are plans for these staff members to both obtain their registered managers award qualifications. Each member of the management team has responsibility for specific tasks and duties. This system appears to be working well and provides management cover for the home at all times. The home has recently been updating and improving their quality audit documentation with a view to carrying out a monitoring exercise involving service users, relatives and professionals. This will be taking place during the course of the year. The registered providers do not handle any money for any service users. This is all dealt with by themselves or their family members, representatives or solicitors. If required, the management team can assist service users with paying bills for example hairdressing/chiropody and then invoice the appropriate person accordingly. All maintenance of essential equipment in the home is regularly serviced. This includes fire prevention equipment as well as moving and handling equipment. Health and safety policies and procedures are in place. Staff have undertaken training in infection control. As discussed at the time of the inspection there are plans for policies and procedures to be updated generally. Atlantis DS0000008956.V322924.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 3 x 3 x x N/A 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 2 13 3 14 3 15 3 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 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x 3 Atlantis DS0000008956.V322924.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 OP12 OP18 OP29 OP33 Good Practice Recommendations For all staff to ensure that when they change/update a care plan they sign and date the information. To evidence that the social care needs of the service users are being met at all times. To access updated Adult Social Care guidance on adult protection procedures. To update the criminal records bureau checks for longer standing staff members. To audit information received re quality monitoring of the home. Atlantis DS0000008956.V322924.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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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