CARE HOMES FOR OLDER PEOPLE
Blackthorns 21-29 Dooley Road Halstead Essex CO9 1JW Lead Inspector
Kay Mehrtens Final Unannounced Inspection 18th January 2006 11:30 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 Blackthorns DS0000017771.V285095.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Blackthorns DS0000017771.V285095.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Blackthorns Address 21-29 Dooley Road Halstead Essex CO9 1JW 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) 01787 472170 01787 476342 Runwood Homes Plc Mrs Rosalind Garnham Care Home 44 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (44) of places Blackthorns DS0000017771.V285095.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 44 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 23 persons) The total number of service users accommodated in the home must not exceed 44 persons Staffing levels will be monitored over the first six months and will be reviewed with the inspectors six months after the date of the registration The registered person must not admit persons subject to the Mental Health Act 1983 or the Patients in the Community (Amendment) Act 1995 9th June 2005 Date of last inspection Brief Description of the Service: Blackthorns provide residential care for thirty-nine residents within a four units. The home has a large lounge for all service users and each of the four units has its own communal area. The home is purpose built; recent building work has increased the number of registered rooms to 44. The home also provides accommodation for 5 people on a short-term respite basis. Most of these service users access the day centre located adjacent to the home. The external day care service users access their centre through its own separate entrance. Blackthorns DS0000017771.V285095.R01.S.doc Version 5.1 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 18th January 2006. This was the second statutory inspection of the year and focussed on the remaining key standards not inspected at the last inspection, as well as a review of the requirements and recommendations from the last inspection. The inspection process included: discussions with the home’s manager, care staff, residents, visiting relatives and a social worker. Information was also provided by the manager, at the request of the Commission, as part of the inspection process. However, this did not arrive at the commission office until 25th January 2006. The premises were inspected, including the grounds. Samples of records and residents care plans were inspected. The inspection covered nine standards. Additional requirements were made to those not addressed from the last inspection. An immediate requirement was made with regard to staffing levels and the provider was requested to respond. The providers’ response is referred to within this report. The manager and staff were very cooperative throughout the inspection. What the service does well:
The home benefits from a stable staff group. The manager works well with the staff group to meet the needs of the residents. Residents and relatives spoke very highly of the manager and staff. Blackthorns DS0000017771.V285095.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
Am immediate requirement regarding staffing levels was sent to the provider due to on-going concerns regarding the staffing levels. Monitoring and inspections have also highlighted concerns regarding the high level of falls in the home and the need to improve activities and care provision for residents with dementia. Several of the requirements from previous inspections have not been addressed. These include the need to provide a loop system for residents with hearing impairment, redecoration and repair of different parts of the home including the need to replace a corridor carpet and the provision of a service agreement/contract for respite residents. In response to repeated requirements, the provider has informed the commission of their intention to rebuild on the site but there is no fixed date. It is not acceptable for residents to live in accommodation that is in need of repair, redecoration and improvement until such time as building plans and processes are put into place. The home is registered to care for older people with dementia. The number of residents with dementia has increased since the last inspection. Whilst the staff are very caring there was little evidence of meaningful interaction and activities that demonstrated good practice in the care of people with dementia. The manager was advised to develop dementia training and skills for care staff so that the “dementia element” of care practice is more evident and better meets the needs of the residents. Am immediate requirement regarding staffing levels was sent to the provider due to on-going concerns regarding the staffing levels. Monitoring and inspections have also highlighted concerns regarding the high level of falls in the home and the need to improve activities and care provision for residents with dementia. Several of the requirements from previous inspections have not been addressed. These include the need to provide a loop system for residents with hearing impairment, redecoration and repair of different parts of the home including the need to replace a corridor carpet and the provision of a service agreement/contract for respite residents. In response to repeated requirements, the provider has informed the commission of their intention to
Blackthorns DS0000017771.V285095.R01.S.doc Version 5.1 Page 7 rebuild on the site but there is no fixed date. It is not acceptable for residents to live in accommodation that is in need of repair, redecoration and improvement until such time as building plans and processes are put into place. The home is registered to care for older people with dementia. The number of residents with dementia has increased since the last inspection. Whilst the staff are very caring there was little evidence of meaningful interaction and activities that demonstrated good practice in the care of people with dementia. The manager was advised to develop dementia training and skills for care staff so that the “dementia element” of care practice is more evident and better meets the needs of the residents. 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. Blackthorns DS0000017771.V285095.R01.S.doc Version 5.1 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 Blackthorns DS0000017771.V285095.R01.S.doc Version 5.1 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): Standard 6 is not applicable EVIDENCE: These standards were not inspected at this inspection. Blackthorns DS0000017771.V285095.R01.S.doc Version 5.1 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 the following standard(s): EVIDENCE: These standards were not inspected at this inspection. Blackthorns DS0000017771.V285095.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 & 15 Residents’ choice is respected in many aspects of their life in the home. Catering arrangements are good. EVIDENCE: Residents are supported should they wish to manage their own affairs. There is information available for access to a local advocacy service, if required. The staff were observed to offer residents choice in various aspects of their life in the home and this was also reflected in care plans and risk assessments. However, the inspector was concerned to see several residents that were not able to voice a clear opinion, taken to the dining table an hour before lunch and left waiting with little interaction or stimulation. The inspector was aware that the carpet in one unit was being cleaned but even so it was not appropriate for the residents to be sitting at the dining table for such a long time. This seemed to be more for the benefit of staff than residents. This was raised with the manager. Residents’ bedrooms contained lots of personal items, as they are encouraged to bring them when moving into the home.
Blackthorns DS0000017771.V285095.R01.S.doc Version 5.1 Page 12 The residents were very complimentary regarding the meals and snacks provided in the home. Several told the inspector that the “food was lovely”. The menu is displayed in each unit so residents were able to make a choice as well as chat about the day’s meals. The menu offered a good choice and nutritious diet as well as “old fashioned” treats and puddings. The lunch, on the day of inspection was a choice of lamb chops or cheese and ham omelette with a selection of vegetables and a homemade lemon meringue pie to follow. All was well presented and much enjoyed by the residents. The cook was well aware of the varied dietary needs of residents and appropriate training and advice had been sought with regard to diabetes. Blackthorns DS0000017771.V285095.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not inspected at this inspection. Blackthorns DS0000017771.V285095.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 The standard of maintenance in the home is not satisfactory. EVIDENCE: The premises were inspected in order to monitor the requirements from the last inspection. Some of the requirements from the last inspection had been addressed. This included some redecoration and repairs to the hairdressing room and checks to the electrics in this room. However, other requirements regarding the stained and worn corridor carpets and the need for a loop system for residents with hearing impairment had not been addressed. The provider has informed the commission of their intention to rebuild on the site but there is no fixed date. It is not acceptable for residents to live in accommodation that is in need of repair, redecoration and improvement until such time as building plans and processes are put into place. The provider should address the shortfalls already stated above
Blackthorns DS0000017771.V285095.R01.S.doc Version 5.1 Page 15 and redecorate and repair several bedrooms and corridor areas that have wheelchair/hoist damage and “tired” décor. The home is spilt into units, which provide a homely and cosy place for residents. The home was clean and free from offensive odours. Blackthorns DS0000017771.V285095.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 Staffing levels are not sufficient to meet the needs of the residents. EVIDENCE: Two items of information, with regard to dependency levels and staffing hours, were sent to the commission in response to the inspection and the immediate requirement notice. There was no indication as to how the dependency levels were calculated. Reference was made to the Residential Care Forum staff calculator, a guidance tool recommended by the Department of Health, for staffing levels though the hours stated did not correspond to the calculation undertaken by the commission. The difference being a shortfall of 34.6 hours based on the information provided as part of the inspection documents. The manager and provider should review staffing levels to ensure that they are consistent and meet the assessed needs of the residents accommodated. The home does care for residents with dementia and staffing should be appropriate to meet both their physical and emotional needs. The information provided at the inspection with regard to the number of dementia residents accommodated differs from that stated in the information provided by the manager after the inspection. The inspector was informed that there were 18 residents with dementia though the documents sent to the commission state only 8 residents with dementia. The inspector has requested information from the manager and provider as to their assessments of the residents, as well as a review of staffing levels to meet assessed needs.
Blackthorns DS0000017771.V285095.R01.S.doc Version 5.1 Page 17 The staff rota showed that there was usually one senior and six care staff until 2pm reducing to one senior and 5 care staff for the evening shift. There was then one senior and 2 care staff on duty during the night until 7.30 am when the day staff took over. The home continues to accommodate several residents that stay at the home but go to the attached day centre between 8am to 8pm. These times are therefore a very busy time for staff and have been noted, as part of the monitoring by the commission and manager, as a time when a lot of falls have been recorded. The commission due to concerns about the high level of falls over the past months has monitored the home. This together with the number of residents with dementia and little evidence of sufficient staff time to provide positive interaction with them were the grounds for an immediate requirement to increase staffing levels to meet the needs of all the residents accommodated at the home. The staff were observed to sit and chat with residents and whenever they were in their company they were friendly and polite. Residents told the inspector that the staff “were polite, friendly and lovely” and that staff “looked after them very well”. The inspector also had the opportunity to meet a visiting social worker and relatives. All expressed the opinion that the care provided was good. The social worker appreciated the support provided by the home for relatives and felt that they had a good working relationship. The staff showed a good understanding of residents’ care and personal needs. However, the inspector was disappointed to see one member of staff chewing gum whilst on duty. This is not good practice especially as it inhibits the communication and understanding of residents with hearing difficulties. This was brought to the attention of the manager. Blackthorns DS0000017771.V285095.R01.S.doc Version 5.1 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 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): 33, 35 & 38 The manager is organised and works well with the staff team to provide a positive and caring home for residents. Residents’ finances were well managed. Practices and procedures ensure that the health and safety of residents are generally well protected. EVIDENCE: The home has annual audits undertaken by their quality assurance team. A development plan is provided for the manager and does include information from the results of service users satisfaction surveys. The manager had
Blackthorns DS0000017771.V285095.R01.S.doc Version 5.1 Page 19 completed the action plan from the previous audit and a copy was provided at the inspection. The last audit of the home took place in September 2005. The manager was addressing some of the recommendations stated as part of the action planning. However, there was no evidence that some recommendations were on target to be met. This included the areas highlighted in this inspection report including the need for contracts for respite residents and as the homes’ audit report states “décor however was poor in many areas… carpets were generally in a poor state of repair as were many items of furniture.” These are concerns shared by the commission and should be addressed by the provider within the timescales stated in the requirements and recommendations of this report. The standard (33.2) requires that “there is an annual development plan for the home, based on a systematic cycle of planning – action – review, reflecting aims and outcomes for service users”. The homes’ quality audit should meet this standard by addressing the identified recommendations within its report. The records of financial arrangements and support for residents were well organised and maintained. The administration and access to residents’ monies was well managed. The systems in place gave a clear audit of all transactions. The manager was very aware of her responsibilities with regard to health and safety of residents and recognised the need to address the health and safety requirements from previous inspections. Health and safety records were well organised. The required checks with regard to electrics, hoists, gas, lift and water temperatures are maintained and monitored. Regulation 37 reports had been recorded and forwarded, as appropriate, to the commission. The manager had worked well with the commission in monitoring accidents and falls in the home. Additional advice was being sought from the falls prevention team, local doctor and rapid assessment unit. Risk assessments had been completed and the manager had sought advice from the local environmental health office and health and safety advisor. Fire training and fire drills were current and well recorded. Blackthorns DS0000017771.V285095.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 1 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 1 X X 1 X X X X 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 X X 2 X 3 X X 3 Blackthorns DS0000017771.V285095.R01.S.doc Version 5.1 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. Standard OP2 Regulation 5 Requirement Timescale for action 22/02/06 2. OP14 12 3. OP19 12 4. OP19 23 The registered person must ensure that all service users receive a statement of terms and conditions. This refers specifically to the respite/short stay service users. This is a repeat requirement for the 4th time. The timescales for the 20th October 2004 and 14th March 2005 and 9th September 2005, have not been met. The registered person must 22/02/06 ensure that residents’ dignity is maintained. This refers to the practice of seating residents at the table an hour before a meal. The registered person should 22/02/06 address the shortfalls identified in the report with regard to redecoration and maintenance. The registered person must 22/02/06 ensure that the premises are well maintained and do not present a hazard to service users. This refers specifically to the carpets. This is a repeat requirement for the 3rd time. The timescales for the 20th
DS0000017771.V285095.R01.S.doc Version 5.1 Blackthorns Page 22 5. OP22 23 6. OP27 18 7. OP33 10 October 2004, 14th March 2005 and 11th July 2005 have not been met. The registered eprson must ensure that the needs of people with hearing impairment are met through the provision of a loop system. This is a repeat requirement for the 3rd time. The timescales for the 14th March and 11 July have not been met. The registered person must ensure that staff levels are increased to ensure the needs of the service users are met. This is a repeat requirement for the 3rd time. The timescale for 14th March 2005 and 11th July 2005 have not been met. The registered person must ensure that action is progressed within agreed timescales to implement requirements identified in CSCI inspection reports. 22/02/06 18/01/06 22/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard 1 Good Practice Recommendations None Blackthorns DS0000017771.V285095.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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