CARE HOMES FOR OLDER PEOPLE
Caroline House 7 Ersham Road Hailsham East Sussex BN27 3LG
Lead Inspector Nigel Thompson Unannounced 19 April 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. Caroline House Version 1.10 Page 3 SERVICE INFORMATION
Name of service Caroline House Address 7 Ersham Road Hailsham East Sussex BN27 3LG 01323 841073 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) Mr Thuraisamy Ravichandran Mrs Pamela Hodger Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (OP) 24 of places Caroline House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The maximum number of service users to be accommodated is twenty four (24). 2. That only service users who have reached the age of sixty five (65) be admitted. Date of last inspection 7 September 2004 Brief Description of the Service: Caroline House is a large, detached three storey Victorian house situated in a quiet residential area of Hailsham, close to the town centre.It is registered to provide care and accommodation for 24 older people, not falling within any other category. There are two lounges and a dining area on the ground floor. Menus are varied, well balanced and nutritious. Meals are served either in the dining area or in the resident’s room. At the rear of the house there is easy access to a large, landscaped garden, which is both safe and secure. There are ample car parking facilities at the front of the home. All rooms are equipped with a TV point, telephone and alarm call system. Rooms that do not have ensuite facilities are fitted with washbasins. A passenger lift provides access to all floors. Caroline House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five hours in April 2005. It found that many of the twenty National Minimum Standards assessed had been met or partially met and the overall quality of care provided was good. Service users and relatives spoken to during the inspection expressed general satisfaction with the home, the staff and the service provided. A tour of the premises took place and documentation, including service user and staff files were inspected. Two of the service users’ relatives, all the staff on duty and seven of the twenty one residents were spoken to. What the service does well:
The relaxed, homely and welcoming environment has evolved over several years and reflects the positive attitude and general stability within the staff team and the open and inclusive management style. Independence is promoted within the home and service user consultation and involvement in day-to-day decision making is encouraged. Regular residents’ meetings provide opportunity to discuss many aspects of daily life including menu planning, activities and colour schemes for communal areas within he home. The standard of the environment within the home continues to improve and provides service users with a clean, comfortable and pleasant place to live. Overall standards of care remain high and individual residents spoken to during the inspection expressed satisfaction with the service provided. Caroline House Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Service users’ care plans were found to be poorly maintained and the recording systems need to be reviewed, to ensure that vital information is not lost and individual plans reflect the changing needs and current objectives for health and personal care. Formal staff supervision is not currently being provided and, following discussion with the manager and deputy manager, the need for specific training on this issue was identified. Satisfaction questionnaires are to be developed, as part of an improved quality assurance system within the home, to obtain the views of residents’ family, friends and other visitors on how care services are being provided. Staffing levels in the home are to be kept under review to ensure that sufficient staff are on duty, at all times, to meet the assessed needs of service users. More stimulating activities should be introduced to reflect the individual and collective interests of service users, as identified in recent residents’ meetings. Caroline House Version 1.10 Page 7 Linked to this lack of organised activities, more imaginative seating arrangements could be developed in the main lounge, where currently chairs are placed around the walls and residents have little opportunity for social interaction. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Caroline House Version 1.10 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 Caroline House Version 1.10 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) 2 & 6 Progress has been made to improve the admission procedure to ensure that there is a thorough assessment carried out prior to people moving into the service. This process enables individual care needs to be addressed and met. EVIDENCE: Following a referral to the home, the manager completes a comprehensive assessment of the individual’s physical and mental condition as well as their personal and social care needs. Individual records are kept for each service user and inspection of the files for the three most recent admissions to the home found that ‘Initial Resident Assessment’ forms had been completed. As well as the personal and social care needs of the individual, the profile and assessment includes details such as environment, communication and mobility. Intermediate care is not provided at Caroline House. Caroline House Version 1.10 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 The current random recording of service users’ progress notes is inadequate and unsatisfactory and may result in significant events or changes being missed and vital information not being documented. The systems for the administration of medication are good with clear and comprehensive arrangements in place to ensure service users’ medication needs are met. EVIDENCE: Individual care plans for several service users were found to be poorly maintained. Significant events in the home had not been documented. In one case a resident had been moved from a first floor room to the ground floor, yet no details had been recorded. Care plans had not been reviewed since October 2004 and daily ‘progress notes’ for one service user had not been updated since February. Details of service users’ weights had not been entered in care plans. The manager confirmed that, whenever possible, the service user (and/or a relative or representative) is involved in drawing up and reviewing the
Caroline House Version 1.10 Page 11 individual care plans. This was confirmed by a relative, spoken with during the inspection. Policies and procedures are in place in relation to the receipt, recording, storage and administering of medicines. Medication administration records were inspected and found to be accurate, up to date and well maintained. Following risk assessments, there are currently no service users taking responsibility for their own medication. Caroline House Version 1.10 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 The meals in the home are balanced and nutritious, offering both choice and variety and catering for special dietary needs. Social and recreational activities are not well managed or creative and do not provide daily variety and interest for people living in the home. EVIDENCE: The experienced cook, in consultation with service users, has developed a fourweek rolling menu which is both varied and balanced and offers seasonal variations. An alternative option to the main midday meal and the supper is available, on request. Individual likes, dislikes and preferences are recorded and are taken into consideration when planning menus. Service users spoken to during the inspection expressed a high level of satisfaction with the standard and choice of meals provided. Caroline House Version 1.10 Page 13 An activities co-ordinator recently employed in the home proved unsuccessful, with some service users feeling patronised, by being asked to make greetings cards and paint pictures, which were then displayed on the walls. At recent service users meetings, there have been requests for more outings, quizzes and exercise to music. This was further reinforced by residents and relatives spoken to during the inspection. The manger confirmed that staff are keen to respond positively to these requests and is hopeful that the issues can be addressed. Visiting to the home is unrestricted and service users are able to receive visitors in the lounge or in the privacy of their own room. Caroline House Version 1.10 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 home has a satisfactory complaints system with some evidence that service users feel that their views and any concerns are listened to and acted upon. Service users are safeguarded from abuse through robust policies, procedures and relevant staff training. EVIDENCE: Policies and procedures relating to abuse and including whistle blowing are in place and have been reviewed and updated. The manager stated that abuse training is provided for all staff and this claim was supported by training records and confirmed by members of staff themselves. A clear and accessible complaints procedure has been produced and is in place in the entrance hall. Service users, members of staff and a relative spoken to during the inspection, confirmed that they would have no hesitation speaking to the manager or making a complaint if necessary and each person was confident that they would be listened to. Caroline House Version 1.10 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, 25 & 26 Redecoration, refurbishment and general improvements have been made to the physical environment, including service users’ rooms, providing people living in the home with safe, comfortable and pleasant surroundings. EVIDENCE: Since the previous inspection the programme of redecoration and partial refurbishment has continued, with several service users’ rooms having been redecorated and one bedroom carpet replaced. Residents are clearly happy with the home and their rooms. ‘I’m very happy with my room’. ‘It’s so clean and comfortable here’. It was evident that many of the rooms have been personalised, with pictures, family photographs and other small items of furniture and personal belongings, to reflect individual taste, choice and preference. Caroline House Version 1.10 Page 16 In some communal areas, particularly the main lounge, more imaginative seating could be implemented. Currently all the chairs are lined up around the walls, in an institutionalised fashion and service users – who tend to sit in the same chair day after day - have little opportunity for social interaction. During the inspection, the manager and staff attempted to create a more sociable environment by moving chairs into small clusters. Although this met with a mixed response from residents, it is hoped that the home will persevere with these changes. All hot water outlets accessible to service uses have been fitted with thermostatic regulators and the manager confirmed that random checks are carried out to ensure that water is delivered at or close to the prescribed temperature. The heated towel rail in the first floor bathroom has now been covered, as required. It was noted that levels of cleanliness and hygiene remains generally high throughout the home and it is hoped that with the recent change in domestic staff, this standard will be maintained. Caroline House Version 1.10 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, 29 & 30 There are generally sufficient staff on duty at all times to meet the assessed needs of the service users. However this needs to be regularly reviewed to ensure consistency of care. EVIDENCE: Although for the majority of time there are sufficient staff on duty, it was evident from discussions with service users and relatives that the overall quality of care can sometimes be compromised by reduced staffing levels, particularly at weekends. A relative spoke of ‘staff too busy to spend time with residents in the lounge’ and of ‘the lack of any real stimulation’. A service user spoke of having a cooked evening meal when there are three staff on duty but receiving sandwiches when there was only two on. ‘ The do their best but sometimes they are just too busy’. No new staff have been appointed at Caroline House since the previous inspection, when unsatisfactory recruitment procedures were identified. The manager was able to confirm that the overall selection and recruitment process has since been reviewed , however it was not possible on this occasion to assess any improvement. Caroline House Version 1.10 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) 33, 36 & 38 Up to date policies and procedures relating to health and safety ensure the health, safety and welfare of all service users and staff. EVIDENCE: Staff spoken to were aware of and adhered to policies and procedures, relating to health and safety. The majority of staff have received relevant training in manual handling, first aid and fire safety. The cook also holds certificates in food hygiene. All training is recorded. Caroline House Version 1.10 Page 19 The manager or deputy manager carries out routine environmental risk assessments. Feedback from service users, regarding the care they receive, is sought by the use of satisfaction questionnaires. However there is currently no organised system for sending out questionnaires or collating responses. The format of the questionnaires, which consist of simple tick box question and answers is very basic and should be amended and improved. It was also noted that the views of relatives, friends and other visitors to the home are not currently sought and, following discussion with the manager, the home will be now be reviewing their quality assurance systems and addressing this issue. Formal staff supervision is not currently being carried out, as required. This was acknowledged by the manager and confirmed by other members of staff. The need for relevant and specific training for the deputy manager was identified and discussed during the inspection. Caroline House Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x 3 3 STAFFING Standard No Score 27 2 28 x 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 x 3 x x 2 x x 2 x 3 Caroline House Version 1.10 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 12 Regulation 16 (2) Requirement Timescale for action 30.06.2005 2. 29 3. 7 4. 33 5. 36 It is required that more imaginative recreational activities are developed to meet the assessed individual and collective social care needs of service users. (Previous timescale oof 31.12.2005 not met). Schedule It is required that the home’s 2 current recruitment process be Regulation reviewed and a thorough 7, 9, 19. procedure put in place, ensuring the protection of service users. 15 It is required that service users care plans are reviewed and updated to reflect changing needs and current objectives for health and personal care. 24 (1) It is required that an effective quality assurance system is developed and implemented to seek the views of service users family, friends and other visitos to the home, on how care services are provided. 18 (2) It is required that all care staff receive formal supervision at least six times a year. 31.05.2005 30.06.2005 30.06.2005 30.06.2005 Caroline House Version 1.10 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 20 36 Good Practice Recommendations It is recommended that seating arrangemnts in the main lounge be reviewed to prvide more opportunity for social interaction. It is recommended that the deputy manager undertakes specific training in relation to the provision of formal staff supervision. Caroline House Version 1.10 Page 23 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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