CARE HOMES FOR OLDER PEOPLE
Autumn House Nursing Home 2 Station Road Worsbrough Dale Barnsley S70 4SY Lead Inspector
Janis Robinson Unannounced 9 August 2005 09:00 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. Autumn House Nursing Home J51 S6470 Autumn House V242450 09.08.05 UI Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Autumn House Nursing Home Address 2 Station Road Worsbrough Dale Barnsley S70 4SY 01226 243057 01226 243057 None Mrs Nurjahan Hossain Mrs Vijay Kumari Singh Mrs Patricia Ann Davison N - Care Home with Nursing 35 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) Category(ies) of OP - Old age (35) registration, with number of places Autumn House Nursing Home J51 S6470 Autumn House V242450 09.08.05 UI Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Persons accommodated shall be aged 60 years and above. Of the 35 beds registered, all can be used for personal care. Twenty of these can alternatively be used for nursing care. Date of last inspection 13 April 2005 Brief Description of the Service: Autumn House is a care home providing personal and nursing care for up to 35 older people. The home is situated in a residential area of Worsborough Dale, close to all local ammenities and bus routes. Accommodation is provided over two floors served by a passenger lift and stairs. The home has 23 single and 6 double rooms, 3 of the double rooms have en-suite facilities. Communal accommodation consists of 2 lounges, one dining room and a visitors lounge. Sufficient bathing facilities are available, with aids and adaptations in place. A central kitchen and laundry serve the home. The home is in an elevated position in its own grounds, and is reached by a steep tree lined driveway. Car parking is available. Autumn House Nursing Home J51 S6470 Autumn House V242450 09.08.05 UI Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 3.5 hours from 9.00am to 12:30 mid-day. An inspection of the environment was undertaken. A proportion of records were checked, including care plans, complaints, menu, rotas, staff training, health and safety and fire records. Interactions between staff and residents were observed. Eight residents and the majority of staff were spoken with. One member of staff was formally interviewed. Discussions with the homes manager took place. What the service does well:
The interactions observed between residents and staff appeared caring and respectful. All of the comments made by residents were positive. They said that they were `very happy’, and `the home is champion’. Residents said staff were `very good’, `kind’, and `considerate, nothing is too much trouble’. A service user guide had been provided to each resident to give him or her information about the home. The manager undertook assessments prior to admission, to ensure individual needs could be met. Trial visits took place, to enable prospective residents and their representatives to make informed choices. Staff undertook a range of training to keep them up to date and ensure they were able to meet residents’ needs. Care plans were in place for all residents. These were well set out and easy to read. They set out all aspects of personal, social and health care needs and recorded the staff action required to ensure all identified needs were met. Residents’ health care was monitored and access to health specialists was available. Residents confirmed that staff were respectful towards them. The routines at the home were flexible and residents were free to choose how to spend their day. A range of activities was available, which residents were free to participate in. All of the residents said they enjoyed the activities provided. There was an open visiting policy, to encourage contact with relatives and friends. The menu was varied, and choices were offered at mealtimes to respect residents’ preferences and maintain health. All of the residents said the food was `very good’, and `plentiful’. There was a complaints procedure and adult protection procedure in place, to promote residents safety. All of the residents said they had confidence in the homes manager and staff, who would listen to any concerns and take them seriously. Residents said that they felt safe at the home. Autumn House Nursing Home J51 S6470 Autumn House V242450 09.08.05 UI Stage 4.doc Version 1.40 Page 6 The environment was well decorated, well maintained, clean and fresh smelling. Communal areas contained homely touches to provide a comfortable environment. Bedrooms contained personal belongings, which enabled residents to have some control over their personal space. Sufficient bathing facilities were provided to ensure residents personal care needs were met. The central laundry and kitchen were well equipped to meet residents’ needs. Agreed levels of staff were being maintained. A staff training plan, and individual training records were maintained. A business plan was in place, and insurance cover was provided. Staff supervision took place, to support and give guidance to staff on an individual basis. Records within the home were stored securely, to safeguard confidentiality. Health and safety procedures were identified and carried out, and systems were checked and serviced to maintain a safe environment. Mandatory training took place, to equip staff with the essential skills needed. 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. Autumn House Nursing Home J51 S6470 Autumn House V242450 09.08.05 UI Stage 4.doc Version 1.40 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 Autumn House Nursing Home J51 S6470 Autumn House V242450 09.08.05 UI Stage 4.doc Version 1.40 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) 1,3,4 and 5. Standard 6 does not apply to this home. A statement of purpose and service user guide were available, to inform residents about the home. Assessments of needs were undertaken prior to admission to ensure that the needs of prospective residents could be met. Trial visits were encouraged to enable prospective residents to look around the home, meet residents, staff and give them the information needed to make informed choices. Staff undertook periodic training to keep them up to date and access to specialist services was arranged, in order that all assessed needs were met. The information available and actions taken ensured that standards were met. EVIDENCE: Each resident had a service user guide, to inform him or her about the home. These were provided in each bedroom, and copies of the service user guide and statement of purpose were on display in the entrance area of the home. Assessments of needs were in place, and copies of social workers assessments were obtained prior to admission, if available, so that a decision could be made about whether the residents’ needs could be met.
Autumn House Nursing Home J51 S6470 Autumn House V242450 09.08.05 UI Stage 4.doc Version 1.40 Page 9 All of the residents said the home met their needs. Residents said ‘we are very well looked after, the staff are wonderful’, `the home is second to none, I cannot think of anything else I need’, `champion, we are very happy’. Residents confirmed that they had access to specialists at hospitals, and health professionals, such as dentists, opticians and chiropodists, so that all of their health care needs were met. Residents confirmed that they had been able to look around the home, stay for a meal and meet residents and staff, who provided them with the information they needed before choosing to move in. Autumn House Nursing Home J51 S6470 Autumn House V242450 09.08.05 UI Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 and 11. Each resident had a care plan, to give staff the information needed to ensure all care needs were met. Health care was monitored, assessed and met. Staff respected residents privacy and appeared respectful towards them. Medication was securely stored and dispensed safely. Procedures were in place to ensure residents were treated respectfully and sensitively when they were seriously ill. EVIDENCE: Care plans contained a range of information. These contained specific information on all aspects of personal, social and health care needs. The plans included information on the staff action required to ensure assessed needs were met. Residents were aware of their right to access their records, but those spoken to chose not to do so. Staff were aware of the contents of care plans and were knowledgeable about residents individual needs. Care plans were reviewed regularly to ensure that they were up to date and relevant information was recorded. The plans contained detail of all health care contacts, appointments and treatments, to ensure health was maintained. Residents’ health was monitored and access to specialists at hospitals, chiropodists, dentists and other health care professionals was available. Residents confirmed that they could see their GP and other professional visitors in private.
Autumn House Nursing Home J51 S6470 Autumn House V242450 09.08.05 UI Stage 4.doc Version 1.40 Page 11 The manager had developed a pro-forma for residents to sign to consent to staff administering medication. These needed to be completed and placed in care plans. Staff were observed respecting privacy by knocking on doors before entering. The interactions between staff and residents appeared respectful and caring. Residents made positive comments about their care. One resident said `I am very well looked after, the staff are marvellous’. Several residents said` the home is very good’. Residents’ wishes regarding funeral arrangements had not been recorded to ensure they were carried out. Autumn House Nursing Home J51 S6470 Autumn House V242450 09.08.05 UI Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 Residents were able to make choices about how they spent their time. A range of activities was offered to residents, to promote choice and maintain interests. An open visiting policy was in place, in order to develop and maintain good relationships with residents’ family and friends. A varied menu was provided and choices were offered to respect personal preferences. EVIDENCE: Residents said they were able to get up and go to bed when they chose, and were seen to use different areas of the home according to their preference. A range of appropriate social opportunities were available, which included weekly bingo, exercise, baking and some trips out of the home. Residents said that they really enjoyed the activities provided, and shared much laughter. Entertainers regularly visited the home. Residents confirmed that they were able to see their visitors in private. Those spoken to said their visitors could come at any time, and the home helped them maintain contact. Residents were able to bring personal items with them into the home. All of the bedrooms were individually personalised and very homely. This was important to residents as it helped them retain control over their immediate environment. One resident said `having my own things around me makes a big difference, it really feels like my home’.
Autumn House Nursing Home J51 S6470 Autumn House V242450 09.08.05 UI Stage 4.doc Version 1.40 Page 13 The menu was varied and a balanced diet was provided to maintain residents health. Choices were offered on a daily basis. All of the residents said the food at the home was very good. One resident said that they enjoyed the full English breakfast offered each day, and it was their favourite meal. Autumn House Nursing Home J51 S6470 Autumn House V242450 09.08.05 UI Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17 and 18 A clear and accessible complaints procedure was in place, to ensure residents’ rights were protected and any concerns listened to and taken seriously. Resident’s legal rights were protected. An adult protection procedure was in place, to ensure residents safety was promoted. EVIDENCE: Each resident and representative had been provided with a copy of the homes complaints procedure. This contained relevant detail and informed the reader of who to contact outside of the home to make a complaint, should they wish to do so. All of the residents said they had no concerns and could go to the manager and staff to sort out any worries they had. The home kept a record of complaints, which detailed the action taken and outcomes. The home had not received any complaints since the last inspection. Residents were able to vote at election time. Access to advocacy services was available. An adult protection procedure was in place, which contained information on the Department of Health guidance `No Secrets’. Staff undertook training on adult protection to equip them with the skills needed to respond appropriately to any allegations. All residents said that they felt safe at the home. Autumn House Nursing Home J51 S6470 Autumn House V242450 09.08.05 UI Stage 4.doc Version 1.40 Page 15 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) 19,20,21,22,23,24,25 and 26. The home was well maintained. The environment was clean, and fresh smelling. Appropriate facilities were provided to meet residents needs. All areas of the home were accessible. Homely touches had been provided to create a comfortable environment. Communal areas were well maintained, and residents’ bedrooms were well decorated and personalised. Some refurbishment was required to one carpet and bedroom furniture to maintain standards. Autumn House Nursing Home J51 S6470 Autumn House V242450 09.08.05 UI Stage 4.doc Version 1.40 Page 16 EVIDENCE: The environment was well decorated. Communal areas were comfortable, however, one section of ground floor corridor carpet was worn and stained. All of the bedrooms seen were well decorated and highly individual, reflecting the residents’ personal taste. Bedrooms contained personal belongings, which enabled residents to have some control over their personal space. However, some bedroom furniture was old and worn and required replacing. There were sufficient communal bathrooms and showers, with appropriate aids and adaptations in place, which met residents’ needs. A rolling redecoration programme was in place to maintain standards. All of the residents said that they were very happy with the accommodation provided. The homes kitchen and laundry contained the equipment needed to provide for residents. Autumn House Nursing Home J51 S6470 Autumn House V242450 09.08.05 UI Stage 4.doc Version 1.40 Page 17 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) 27,28 and 30 Agreed levels of staff were being maintained. Some staff undertook NVQ training to improve their skills. The homes recruitment practices ensured a thorough procedure was in operation. Staff undertook periodic training to keep them up to date. A staff training plan and individual training records were kept to monitor staff training. EVIDENCE: The homes rota indicated that agreed levels of staff were being maintained. Residents felt that enough staff were provided. Of the thirty care staff, eleven staff had achieved NVQ level 2 or 3 in care. Eight further staff were undertaking the training. The homes two care managers had almost completed NVQ at level 4 in management and care. Staff training records were maintained to ensure all staff had undertaken relevant training. Staff confirmed that they undertook induction and foundation training to familiarise themselves with the home and understand the requirements of their role. Staff said that they received sufficient training to be able to carry out their duties. Residents said that staff had the skills to do their job well. Staff appeared competent to carry out their duties; they displayed an understanding of individual residents needs and were able to give examples of good practice. The interactions between staff and residents appeared positive. Staff had a caring and patient approach. Autumn House Nursing Home J51 S6470 Autumn House V242450 09.08.05 UI Stage 4.doc Version 1.40 Page 18 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) 31,32,34,35,36,37 and 38. The management’s clear leadership benefited residents and staff. A business plan was in place. Systems were in place to ensure resident’s finances were protested. Staff received formal supervision for development and support. The records were stored securely, to respect residents’ rights. Policies and procedures for the smooth running of the home and care of residents were in place and accessible to staff. Staff undertook mandatory training. A health and safety policy was in operation. Fire systems had been checked at the required frequency to ensure they were in working order. EVIDENCE: The manager was a Registered General Nurse with many years experience in the caring profession. She had undertaken the Registered manager’s award. Staff and residents said the manager was approachable and supportive. Autumn House Nursing Home J51 S6470 Autumn House V242450 09.08.05 UI Stage 4.doc Version 1.40 Page 19 The majority of residents looked after their own finances. The home kept relevant records for small amounts of spending monies for one resident. Records kept tallied with the amounts recorded. Formal staff supervision, to develop, inform and support staff took place, in addition staff reported that the manager had an open door policy, and was always available. Records were stored securely in the home to respect residents’ confidentiality. A health and safety policy was in place to protect staff and residents. Fire exits were clear and fire doors closed on their rebates. Records confirmed that fire-fighting equipment was checked and serviced, weekly checks of the fire alarm to ensure it was in working order had taken place. Staff were up to date with mandatory training to equip them with the essential skills needed to promote the well being of residents. Fire records evidenced that staff undertook fire training at the required frequency. Autumn House Nursing Home J51 S6470 Autumn House V242450 09.08.05 UI Stage 4.doc Version 1.40 Page 20 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 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 x 3 3 3 3 3 Autumn House Nursing Home J51 S6470 Autumn House V242450 09.08.05 UI Stage 4.doc Version 1.40 Page 21 Are there any outstanding requirements from the last inspection? Yes 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. 2. 3. 4. Standard 9 11 19 24 Regulation 17 12 23 23 Requirement Timescale for action 31.10.05 Consent to medication must be recorded in care plans. (Previous timescale of 06.07.05 not met). Residents wishes regarding 31.10.05 funeral arrangements must be recorded in care plans. The marked and worn section of 30.11.05 ground floor corridor carpet must be replaced. An audit of bedroom furniture 31.10.05 must take place. A rolling programme of the replacement of worn furniture must be recorded and put into operation. 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 None Good Practice Recommendations Autumn House Nursing Home J51 S6470 Autumn House V242450 09.08.05 UI Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Ground Floor, Unit 3 Waterside Court Bold Street Sheffield, S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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