CARE HOMES FOR OLDER PEOPLE
Calderthwaite The Banks Seascale Cumbria CA20 1QP Lead Inspector
Nancy Saich Unannounced 23 August 2005 09:30 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. Calderthwaite F58 F10 s22663 calderthwaite v235950 230805 ui stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Calderthwaite Address The Banks Seascale Cumbria CA20 1QP 019467 29292 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) Mrs Mary Rose Holmes Care Home 5 Category(ies) of OP - Old Age registration, with number of places Calderthwaite F58 F10 s22663 calderthwaite v235950 230805 ui stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17 March 2005 Brief Description of the Service: Calderthwaite is a Victorian house in a residential area of Seascale. the home is near to all village amenities including the railway station. Accomodation is on the ground and first floor. Bedrooms are single occupancy with ensuite shower and toilet. There is a lounge/ diningroom on the ground floor. The home can take up to five older adults. Calderthwaite is owned and managed by Mary Holmes. Calderthwaite F58 F10 s22663 calderthwaite v235950 230805 ui stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by Nancy Saich and started at approximately 9.30 a.m and lasted for over four hours. The inspector met with the provider and the staff on duty. She spent time with all five residents and spoke at length with three of them. She toured the building and checked on documents that supported what people said or what she saw. What the service does well:
Mrs Holmes is careful to only admit residents who she feels she can care for properly and who will fit into the existing residents’ group. The home delivers very good standards of care. Residents spoke about the personal attention that Mrs Holmes and her staff give them and they felt that they received extremely good levels of care and attention. The care plans and daily notes backed up what the residents said. One person said, “I feel that I am part of a family living here with Mary…” Residents said they saw the doctor or the district nurse when they wanted and that the provider took them out to health care appointments. Medication was being appropriately managed and two of the residents were encouraged to manage some of this themselves. The staff team were aware of how to care for someone in the last days of life and the inspector saw evidence of this on the day. The residents said they went out with their families or friends but they also said that the provider took them out to local activities or to shop or to meet with friends. They enjoyed these outings as usually they went out just with Mrs Holmes and had her undivided attention. One person who didn’t really want to go far said that the provider encouraged her to go down to the beach on good evenings. All of the residents said that the food was “excellent”, “very good”, “plenty of choice and all home made”. The home has a ‘heartbeat’ award for their catering and the residents said they ate well and looked forward to mealtimes. Each resident has a large single room with a shower, wash hand basin and toilet. These rooms were spacious, well decorated and nicely furnished. Most people enjoy spending their time in their own rooms and each room is set out like a bed sitting room. Calderthwaite F58 F10 s22663 calderthwaite v235950 230805 ui stage 4.doc Version 1.40 Page 6 None of the residents had any complaints. One person who had been resident for a number of years said she had never had any problems “…right from day one everything has been grand…” The inspector saw copies of the complaints procedure in each room and residents were aware of how to complain. None of the residents had any concerns about bad practice. They said “Mary wouldn’t let anything like that happen in our house…” They felt that as Mrs Holmes lives in the house she is aware of everything that goes on in the building. Staff had received training in how to prevent abuse and a new person was spoken to and although she hadn’t had formal training she did know how to contact outside agencies if anything worrying were to happen. The inspector saw the staff timesheets and spoke to staff who were happy with the numbers of staff on duty. Mrs Holmes does a lot of the ‘hands-on’ care herself and residents said they had plenty of attention. They said that even “the young staff have just exactly what it takes to be able to give old people a bit of comfort…” Staff had received good levels of training in all the skills necessary to provide good care to older people. Staff had either completed or were working on their NVQ awards. The home is run using very simple systems that suit the needs of the five residents and the small team of staff. The inspector checked on things like fire and food safety, residents money and maintenance and found them all in order. Mrs Holmes has a system for checking on the quality of the care and services she provides and all of the responses were positive. One person said in a questionnaire “Calderthwaite is a home from home…it’s always a pleasure to visit and the food is fabulous…my relative is very happy and that makes me happy to…” Another person summed it up by telling the inspector, “I feel honoured to live here”. What has improved since the last inspection? What they could do better:
There was nothing major that needed improvement. The inspector did discuss some minor issues that might improve the way records and administration
Calderthwaite F58 F10 s22663 calderthwaite v235950 230805 ui stage 4.doc Version 1.40 Page 7 were organised but these matters did not detract from the very good care provided in the home. 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. Calderthwaite F58 F10 s22663 calderthwaite v235950 230805 ui stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Calderthwaite F58 F10 s22663 calderthwaite v235950 230805 ui stage 4.doc Version 1.40 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 standard(s) 3 The home is good at only admitting new residents who will fit in with the existing group and who the staff team can give good care to. EVIDENCE: There had been no new admissions since the last inspection but residents did speak about coming to visit prior to admission and two of them said that the move to the home was the best move they had ever made. The files and records showed that residents had been assessed both by the provider and by social workers before admission. Calderthwaite F58 F10 s22663 calderthwaite v235950 230805 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) 7,8,9,10,11 The provision of health and personal care is very good in this home with all residents being given sensitive, individualised and appropriate care that is suited to their needs. EVIDENCE: All of the residents had lengthy care plans and risk assessments and these covered all the things the residents felt were appropriate. The provider had started to write daily living plans that gave good detail of all the small – but important – things that make residents feel Calderthwaite is their home. Residents said that the staff were good at supporting them with their personal care and one person said “I just love it when Mary helps me…she gives me such good attention”. A number of people commented on how they enjoyed having a bath and there were lots of relaxing bath oils and other aromatherapy products in the bathroom. Residents spoke about going out to the local surgery or having the doctor visit the home if they were unwell. The district nurse is a regular visitor and residents spoke about being taken out to the optician or chiropodist. Everyone felt their health care was well looked after. Calderthwaite F58 F10 s22663 calderthwaite v235950 230805 ui stage 4.doc Version 1.40 Page 11 Medication stored on their behalf was checked and this was being managed properly. One or two people are supported in managing some of their own medication. Four of the five residents were asked about how staff treated them. They all felt that they were treated with kindness and respect and that the way staff behaved allowed them to retain dignity and choice. One person explained how she was encouraged and persuaded to go out or do things for herself and she realised that this was the way the staff encouraged her to be independent and engaged in life. Another person was allowed to take appropriate risks as she enjoyed going out unaccompanied. One resident was unwell on the day and staff were caring for this person in a sensitive and responsive way. The team were fully aware that this person might be nearing the end of life and they were dealing with both the practical and the psychological tasks to make this person as comfortable as possible. Calderthwaite F58 F10 s22663 calderthwaite v235950 230805 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) 12,13,14,15 This home provides varied and individual activities, involves the local community and residents friends and family and encourages residents to have as much choice and control as possible. EVIDENCE: Residents get up and go to bed as they choose and they can have their meals in their own rooms. Residents said they go out as they wish and one person has a walk into the village or to the beach every day. The residents said they had plenty of visitors and one person said that two of her very young visitors loved being invited for tea and she felt she could entertain her family in the home ‘just like my own home’. Local groups and visitors come to the home and one resident still participates in two local groups. Another person talked about going to an event organised by a political party she belongs to. Staff spoke about a planned lunch outing with residents and their families. Residents said that they were consulted “all the time…Mary is interested in every bit of my life and knows all my likes and dislikes…”. Residents said they were asked about things like food preferences and what they wanted to wear. They were also able to ask to be taken to events or out shopping and they could determine where they were going and what they were going to do. The inspector thought that the residents were very assertive and this is a measure of being given all the options possible.
Calderthwaite F58 F10 s22663 calderthwaite v235950 230805 ui stage 4.doc Version 1.40 Page 13 The residents said the food was “marvellous”, “excellent”, “lovely…nice home cooking” and the home also had a ‘heartbeat award’ for healthy options, a non-smoking environment and excellent food hygiene standards. This home provides a wide range of meals and uses where possible good quality fresh, local produce. There is an emphasis on health but also on meals that everyone will enjoy. Calderthwaite F58 F10 s22663 calderthwaite v235950 230805 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) 16,18 The arrangements for both making complaints and being protected were in order allowing residents to have a voice and also know that they are safe in the care of the home. EVIDENCE: Residents had a copy of the complaints procedure in their rooms but they said they never had to use it. One person said that from the minute she had come to the home years before she had no complaints. Other residents said that the provider would deal with issues before they became complaints. Staff were aware of the complaints procedure and could support staff. Residents said that there were no abusive practices in the home and that the provider would discover any person who was doing something like this as she lives in the home and “knows everything that’s going on…” Staff had received training in the protection of vulnerable adults and could discuss how to report abuse Calderthwaite F58 F10 s22663 calderthwaite v235950 230805 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) 19,26 This home provides a clean, comfortable and attractive environment that residents felt relaxed and safe in. EVIDENCE: The inspector checked all areas of the home and everywhere was clean and tidy. Bedrooms had been redecorated and new curtains and bedspreads purchased since the last visit. The inspector saw documents that showed that things like the gas installation and appliances are regularly maintained. The home has two bedrooms and a small lounge diner on the ground floor and three bedrooms on the first floor. The upper floor is reached by a stair lift. All of the bedrooms are large and those to the front look out over the sea. Most of the residents have double beds and have two easy chairs or a sofa. The rooms are big enough to be considered as bed sitting rooms. Each bedroom has a shower, wash hand basin and toilet ensuite. Residents said that they appreciate these large private rooms and most people enjoy spending time in their own rooms Calderthwaite F58 F10 s22663 calderthwaite v235950 230805 ui stage 4.doc Version 1.40 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 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) 27,28,29,30 Staffing arrangements are good allowing residents to be cared for properly by the staff team. EVIDENCE: The inspector saw the timesheets for some months prior to the inspection. There were usually two members of staff on during the day and one person on duty in the evening. The provider is in the home when there is only one member of staff on duty and she is very much a ‘hands-on’ provider. She is responsible for the care of the residents during the night. The staff in the home have qualifications in care and attend short courses that help them with the daily tasks but also help them to understand the way growing older can change a person. Two new members of staff had been taken on since the last inspection and the paperwork relating to their recruitment was checked and this was in order. The inspector spoke to them and they confirmed that they were being trained and supported by the provider and both felt they were becoming very competent and both enjoyed working in the home. Calderthwaite F58 F10 s22663 calderthwaite v235950 230805 ui stage 4.doc Version 1.40 Page 17 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) 33,35,36,38 The management systems in the home are operating under simple, common sense lines and make the lives of residents and staff safe and comfortable. EVIDENCE: The provider has a simple quality assurance system where she uses regular questionnaires to find out what residents and families think. She gives staff plenty of individual time and attention to make sure they are happy and able to care for the residents properly. Residents’ finances are mainly managed by families but there are good arrangements in place allow the provider to help one person with their finances. The staff had undertaken health and safety training and there was evidence on the day to show that they understood things like infection control and food hygiene. There were no hazards seen on the day. The services in the home are properly checked and maintained. The fire logbook was seen and was in order.
Calderthwaite F58 F10 s22663 calderthwaite v235950 230805 ui stage 4.doc Version 1.40 Page 18 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 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4
COMPLAINTS AND PROTECTION 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 Standard No 16 17 18 Score 3 x 3 x x 3 x 3 3 x 3 Calderthwaite F58 F10 s22663 calderthwaite v235950 230805 ui stage 4.doc Version 1.40 Page 19 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 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. Refer to Standard Good Practice Recommendations Calderthwaite F58 F10 s22663 calderthwaite v235950 230805 ui stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith, Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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