CARE HOMES FOR OLDER PEOPLE
Attwoods Manor Mount Hill Halstead Essex CO9 1SL Lead Inspector
Brian Bailey Unannounced 22nd April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Attwoods Manor I56-I05 S17756 Attwoods V222275 UI 200405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Attwoods Manor Address Mount Hill, Halstead, Essex CO9 1SL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01787 476892 01787 477769 Golden Age Management Limited Mrs Gina Juniper Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Attwoods Manor I56-I05 S17756 Attwoods V222275 UI 200405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 42 persons) The total number of service users accommodated in the home must not exceed 42 persons. Date of last inspection 24th November 2004 Brief Description of the Service: Attwoods Manor is located approximately one mile from the town of Halstead, in a semi rural location. It is a detached period property set within approximately three acres of grounds, which were well tended, and had a pathway around the perimeter for the use of wheelchairs and other mobility equipment. An attractive patio area at the front of the house is an ideal place for service users to sit and look at the garden and meet visitors.There are service user bedrooms and communal areas on two floors. There are twelve bedrooms on the ground floor (eleven singles and one double) and twenty-eight bedrooms on the first floor (twenty-five singles and two doubles). There are four lounge areas and a large dining room. There are various bathing and WC facilities throughout the home. The home is registered for 42 older people who need residential care. They do not offer nursing care, or placements for people with dementia. Attwoods Manor I56-I05 S17756 Attwoods V222275 UI 200405 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 22nd April 2005 from 10.45am until 5.00pm. This was the first inspection of this home in the inspection year 2005/6. During the inspection, the manager, staff, five residents and four visitors gave their views about the home. The majority of residents were seen during the inspection. A tour the building included a check of some bedrooms, bathrooms and the lounges and dining room. Residents’ care records and staffing levels were also checked and the midday meal was observed. What the service does well: What has improved since the last inspection? What they could do better:
The manager must ensure that the home’s responsibilities under the Health and Safety legislation are risk assessed, kept up to date and any identified hazards are remedied without delay. The home’s agreed staffing levels of five staff on duty must be maintained at all times during the day. The senior person in charge of the home must have authority to call on the staff team or obtain agency staff when the need arises.
Attwoods Manor I56-I05 S17756 Attwoods V222275 UI 200405 Stage 4.doc Version 1.30 Page 6 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. Attwoods Manor I56-I05 S17756 Attwoods V222275 UI 200405 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Attwoods Manor I56-I05 S17756 Attwoods V222275 UI 200405 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4 & 6 The admission process is managed well and agreed care is based on assessment. EVIDENCE: Full assessments were available on residents’ files together with information gathered by the home prior to admission. Although the original assessment information was available, this information was not translated into care plans on some files. (See page 10). One resident said that they felt the services provided met their expectations and having only recently moved in, was already feeling fairly settled in the new surroundings. The manager provided an example of how the home only admits people whose needs they can meet. An intermediate care service is not provided at this home. Attwoods Manor I56-I05 S17756 Attwoods V222275 UI 200405 Stage 4.doc Version 1.30 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 standard(s) 7, 10, Some progress has been made on improving the content of care plans, but until they are all brought up to date and reviewed regularly, some residents are at risk of not having all their health and personal care needs met. EVIDENCE: Individual care plans are available and progress has been made to develop them to ensure that all aspects of health, personal and social care needs of residents are identified. Further work is required to ensure all care plans are brought up to date and reviewed on a regular basis. Care records showed that visits by health care professionals were recorded and these were up to date. Observation of care staff during the inspection showed that they were friendly and respectful towards residents, and understood and recognised residents’ rights to privacy and to be treated with dignity. Residents spoken to reported that staff were patient and kind, they enabled residents to preserve their dignity and assisted them with their personal needs in a professional manner. One resident said that they had decided who they wanted to assist them with their personal care needs.
Attwoods Manor I56-I05 S17756 Attwoods V222275 UI 200405 Stage 4.doc Version 1.30 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 15 Residents have a balanced varied and enjoyable diet. Food is well cooked and presented and residents are offered a real choice of meal. Residents are able to maintain and develop friendships in and outside of the home. EVIDENCE: Residents spoken to said that they enjoyed the meals provided and the opportunity to have a choice, which was evident on the day of inspection. The food was well-presented and appetising in appearance and the residents were not rushed. One resident said, “You get ample food here and if you haven’t got your appetite, they will try and offer something”. The dining tables were well laid out and cold drinks were provided. The menus showed cooked breakfasts and hot snacks at teatime. It was evident from discussion, that the cook takes a pride in the food prepared and recognises its importance to the quality of life and health. Residents needing help at the midday meal were served with warm food in a friendly way. Three visitors said that they always felt welcome and could visit without giving any notice. One resident reported that moving to the home had in general been a good experience and said, “you are treated as a person, you couldn’t ask for anymore”.
Attwoods Manor I56-I05 S17756 Attwoods V222275 UI 200405 Stage 4.doc Version 1.30 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Residents were confident that they could make complaints. EVIDENCE: None of these standards were assessed fully at this inspection, although residents spoken to, stated that they would speak to staff if they had any concerns. One resident said that she was unhappy that a toilet near to her bedroom had been closed off and was going to complain if the situation continued. Staff explained that they were aware of the issue and reassured the resident that the matter was being dealt with. Attwoods Manor I56-I05 S17756 Attwoods V222275 UI 200405 Stage 4.doc Version 1.30 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 23, 25 and 26 A comfortable and homely standard of accommodation is provided although the outstanding matter concerning very hot water does not provide residents with a safe environment. EVIDENCE: This is a large detached property that has been adapted to meet the needs of older people. The building is well maintained and decorated and furnished to a good standard. A number of bedrooms were looked at. These were homely in appearance, well decorated and furnished. Many of the bedrooms had been personalised. One resident said that he enjoyed watching television, but “it was better to watch television in your own room, as it’s difficult to concentrate with lots of people in the lounge”. All areas of the home visited were clean, tidy and odour control was good. As indicated under Management, Standard 38, the temperature of the hot water at the taps in the bathrooms is too hot, which places residents at risk. An
Attwoods Manor I56-I05 S17756 Attwoods V222275 UI 200405 Stage 4.doc Version 1.30 Page 13 immediate requirement notice was issued requiring the manager to take urgent action. Attwoods Manor I56-I05 S17756 Attwoods V222275 UI 200405 Stage 4.doc Version 1.30 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The number of staff available was not sufficient to meet the needs of the residents, which has the potential to place residents at risk. EVIDENCE: Staffing levels were below the minimum standard. Only three staff were on duty during the afternoon although the number required is five. The deputy manager was requested to increase the number of staff on duty and chose to return to the home to assist with the care of residents. The staff roster showed that there had been other occasions during the week when only four staff had been on duty. There did not seem to be a procedure for the senior staff member on duty to request help from the existing staff or agency staff when the staff levels fall below five. Attwoods Manor I56-I05 S17756 Attwoods V222275 UI 200405 Stage 4.doc Version 1.30 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The failure to rectify an identified problem with the hot water system results in an unacceptable hazard to residents. EVIDENCE: Hot water outlets in bathrooms were checked and the temperatures recorded were on average, 55 degrees C, which is well above the maximum safety limit of 43 degrees C. An inspection of Attwoods was carried out by a Health and Safety officer on 18th April 2005 and had already identified this problem. There was no evidence to show that appropriate action had been taken and an immediate requirement notice was given to the deputy manager to require the manager to take urgent action to rectify the potential hazard and minimize the risk of an accident to residents. Attwoods Manor I56-I05 S17756 Attwoods V222275 UI 200405 Stage 4.doc Version 1.30 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 3 x x 3 x 1 3 STAFFING Standard No Score 27 1 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x 1 Attwoods Manor I56-I05 S17756 Attwoods V222275 UI 200405 Stage 4.doc Version 1.30 Page 17 yes 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 7 Regulation 15 Requirement Residents care plans must be in sufficent detail to provide staff with clear guidance staff on how to meet their needs. All care plans must be reveiwed regularly (Timescale 1/2/05 not met). The manager must take urgent action to ensure the hot water outlets used by residents are regulated. The manager must ensure that there are five care staff on duty during the day. (Timescale 1/2/05 not met) Timescale for action 1st August 2005 2. 19/25/38 13 6th May 2005 1st May 2005. 3. 27 18 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. Refer to Standard 27 Good Practice Recommendations The manager should ensure senior staff are authorised to recruit staff to cover the roster Attwoods Manor I56-I05 S17756 Attwoods V222275 UI 200405 Stage 4.doc Version 1.30 Page 18 Commission for Social Care Inspection Fairfax House Causton Road Colchester CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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