CARE HOMES FOR OLDER PEOPLE
Catterall House Lancaster New Road Catterall Lancashire PR3 0QA Lead Inspector
Vivienne Morris Unannounced Inspection 17th April 2008 09:00 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 Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 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. Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Catterall House Address Lancaster New Road Catterall Lancashire PR3 0QA 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) 01995 602220 01772 816967 rameshvarshagulati@hotmail.com Dr Varsha Gulati Post Vacant Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Registered numbers to include one (1) named person under 65 years of age 17th April 2007 Date of last inspection Brief Description of the Service: Catterall House is a two-storey building with single accommodation on ground and first floor levels; there is one double bedroom for those wishing to share facilities. Most bedrooms are furnished to a satisfactory standard. The home has adequate car parking space to the side of the house, being situated on a main road position, in the rural area of Catterall on the outskirts of Preston and a short drive from Garstang. It is on a bus route and within walking distance of local shops. Catterall House caters for up to twenty-four elderly people, who require assistance with personal care and the home has been adapted to suit the needs of this category of resident. A passenger lift is installed and ramps are fitted to entrances of the building to allow easy access for those in wheelchairs and the less mobile. The home provides sufficient communal space and there are adequate toilets and bathrooms located throughout, with the main bathroom having an assisted hoist. At the time of this visit to the service the fees for care ranged from £285 to £364.50 per week, with additional costs for hairdressing, chiropody, newspapers, excursions, private physiotherapy and private activities. Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes.
An unannounced site visit was conducted to this service over one day in April 2008, which formed part of the key inspection process. During the course of the site visit, discussions took place with those living at the home, as well as relatives and staff. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas were seen. A comment card was received from one person living at the home and their feedback is reflected throughout this report. Every year the provider completes a self-assessment, which gives information to the Commission about how the home is meeting outcomes for people using the service and how the quality of service provided is monitored. We observed the activity within the home and ‘tracked’ the care of three people during the site visit, not to the exclusion of other residents. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The Commission for Social Care Inspection has received three complaints about this service since the last inspection. One was referred back to the provider to investigate using the home’s complaints procedure. The other two, after a risk analysis led to a random inspection being conducted by the Commission. What the service does well:
One plan of care contained a lot of detailed information, so that staff could form a picture of this person’s needs and therefore provide the care required. A variety of external people were involved in the care of the people living at Catterall House and the management of medications was, in general, satisfactory. The staff team respected people living at the home, ensuring that their privacy and dignity was consistently upheld. The leisure interests and hobbies of those living at the home had been taken into consideration so that they were
Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 6 supported to maintain their individual interests. Staff had a good understanding of the principles of care and promoting privacy and dignity. Nutritious, well-balanced meals were served for residents, in pleasant dining areas and snacks were available at all times. However, people were able to eat their meals within the privacy of their bedrooms, if they preferred. Those spoken to, in general, enjoyed the food served and told us that alternatives to the menu were available, if required. People were seen to be offered choices of meals and beverages were served at regular intervals throughout the day. People living at the home were supported to remain independent for as long as possible and they were encouraged to maintain contact with their family and friends so that they continued to have links with the outside community. Residents’ finances were adequately protected by the home’s policies and procedures, clear record keeping and audited practices. Residents and their families were asked to complete a detailed life history outlining important events, hobbies and interests. This helps to tailor some activities to individual preferences as well as group activities. Visiting was flexible and it was evident that people visiting the home were made to feel welcome and it was confirmed that if people wished to appoint an independent advocate to act on their behalf, then the home would support them to do so. When asked what the service does well, the registered person wrote on the self-assessment, ‘The home has an ‘open access’ policy for visitors, who can visit whenever it is convenient to them and their relatives and friends. Our resident’s religions are respected. We try to provide good quality home made meals, which are nutritious and a choice is of menu is given. We respect residents’ culture, religion and recreational interests’. One person, whose care was ‘tracked’ said, ‘the food is very good’, and another commented, ‘I can’t grumble. The staff are very kind and the meals on the whole are quite good’. One person said that the food was ‘alright’, but the gravy could be a bit thicker. Other than that she had no complaints. The environment was relaxed and the routines of the home were well managed. It was evident that people living at Catterall House were happy and contented. Complaints were well-managed and robust policies and procedures adequately safeguarded people living at the home against abusive situations. The home was clean, tidy and pleasant smelling, providing a comfortable environment for the people living at Catterall House. Residents were able to bring their own possessions to the home if they wished, in order to promote a homely atmosphere. Robust infection control policies and procedures had been
Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 7 adopted by the home so that people were adequately protected from cross infection. The induction and training of staff was satisfactory and a good percentage of care staff were appropriately trained to maintain the standards of care delivered. The systems and equipment within the home had been checked and serviced at regular intervals, ensuring that they were safe for use so that residents and staff were adequately protected. What has improved since the last inspection? What they could do better:
The assessment of people’s needs could be better to ensure that everyone is thoroughly assessed before admission, so that the home is confident that individual needs can be fully met by the staff team. The prospective resident or their relative could be given the opportunity to be involved in the preadmission assessment process so that they have some input into the planning of their care. Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 8 The care planning process could be better by providing clear guidance for staff as to how people’s assessed needs are to be met and by involving all residents in the planning of their individual care. Any unnecessary risks to the health or safety of residents could have been managed better within a risk management framework, to ensure that people are always protected from potential harm. All hand written annotations on Medication Administration Records could be signed, witnessed and countersigned to ensure transcriptions are accurately recorded. Two bedrooms were in need of refurbishment in order to bring them up to an acceptable standard before anyone moves into these rooms. The recruitment practices could have been better. Although some checks had been conducted before people were employed, others had been done after staff had started working at the home, which did not demonstrate that people living at the home were always protected. Although the monitoring of the quality of service provided had improved since the last inspection, it could still be better by conducting more detailed and wider audits and obtaining the views of other people involved in the care of those living at the home, to see how Catterall House is meeting it’s goals for people living there. Meetings for residents, their relatives and also staff could be introduced so that people may openly discuss any concerns or relevant information, which is of interest to people involved 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. The summary of this inspection report can be made available in other formats on request. Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 9 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 Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The preadmission process was not always thorough enough to ensure that the staff team were able to meet everyone’s individual needs. EVIDENCE: When asked what the service does well, the registered person wrote on the self-assessment, ‘we like to think that information we give to our prospective residents is quite comprehensive. We encourage them to visit our care home and we try to answer their queries so that they can make their informed choice about moving into the home. We provide a detailed ‘Information Pack’, which includes the Statement of Purpose & Statement of Terms and Conditions; we give people the opportunity of visiting Catterall House and give them the opportunity of a trial period’. We looked at the care records of three people living at the home. The preadmission process varied, in that, the needs of some people had been
Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 11 assessed before they were admitted to the home to make sure that the staff team could provide the care required. The needs of others had not been sufficiently determined and we were informed that although some people are admitted to the home as emergency cases, not all other people coming to live at Catterall House had been fully assessed before they were admitted. There was no evidence available to show that the residents or their relatives had been given the opportunity to be involved in the assessment of needs before they were admitted to the home, so that they could have some input into planning their care. One person, whose care was ‘tracked’, told us that she was happy living at the home and said, ‘I am able to walk around as I please’. When asked what the service could do better, the registered person stated on the self-assessment, ‘we should review our ‘Statement of Purpose’. We should be more pro-active about the pre-admission assessment process.’ Residents and their relatives, who were spoken with said that they were more than happy with the services provided. Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of people living at the home were not always being met, but the privacy and dignity of residents was consistently respected. The management of medications was, in general satisfactory. EVIDENCE: The care planning process had significantly improved since the previous inspection, although further developments could be made. The new manager of the home had begun to audit the care plans and had realised that a better system could be introduced. The three plans of care examined varied in quality and detail. One of the care records provided a lot of information, giving staff guidance as to how the resident’s needs were to be met, which showed a more person centred approach to care. The other two could have been more detailed in relation to the individual needs of people living at the home. The assessed needs of these two people had been included in the care plan, but there were no instructions for staff as to how these needs were to be met. One care plan had not been developed with the involvement of the resident or their relative, so that they had the opportunity to have some say in the care planned for
Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 13 them and another plan of care had not been reviewed or updated for five months to show that that the needs of this person were being adequately monitored. It is advisable to avoid none specific language in the care records, such as, ‘on request’ and ‘as required’, so that the care of people living at the home is more individualised. It was pleasing to see that some good learning material was available within care records for staff reference, in relation to specific medical conditions. Although a range of risk assessments had been conducted, some identified hazards were not being covered within a risk management framework, particularly in relation to people being at risk of falling and also at risk of malnutrition. Therefore, those living at the home were not always protected from potential hazards. One resident was clearly at risk of falling, but a falls risk assessment had not been conducted, so that her safety was protected. The records of another resident stated ‘under weight’, but a nutritional risk assessment had not been conducted, which did not demonstrate that the possible risk identified was being sufficiently monitored. Staff spoken to told us that it was the responsibility of senior care staff to write the plans of care, but they were familiar with the care planning process and were fully aware of individual assessed needs and how to access further information, should they require it. There was a lot of evidence available to show that other professionals were involved in the care of people living at the home, so that external advice had been sought about any health care needs. The chiropodist was on site at the time of our visit and one person living at the home said, ‘the district nurse comes regularly to redress my leg’, and this information was recorded in the care plan. The plans of care examined demonstrated that the privacy and dignity of those living at the home was an important aspect of care provision. The statement of purpose showed that the home ensured that the privacy and dignity of people was upheld at all times and the residents spoken to confirmed this information. One stated, ‘the staff are lovely. They really look after us well’ and another commented, ‘it is really nice here. The girls help me with my care’. Staff were seen to be treating residents with respect and were heard talking to them in a kind manner. One relative said, ‘I am very satisfied with the care that my relative receives’. Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 14 The policies and procedures in relation to medications were, in general, in line with the Royal Pharmaceutical Society of Great Britain guidelines to cover all aspects of medicines management. The handling of controlled drugs and waste medication was in accordance with current legislation so that those living at the home were protected from drug errors and misuse. However, hand written entries on Medication Administration Records had not always been signed, witnessed and countersigned to ensure that the transcriptions had been accurately recorded. We were told that senior care staff were responsible for administering medications once they have completed the appropriate training, usually through a recognised qualification in care. However, training certificates could not be located at the time of our visit to the home, to show that relevant training had been undertaken. When asked what the service does well, the registered person wrote on the self-assessment, ‘we like to think that we do a good assessment of our service users’ needs, then depending on this we draw up their care-plan’. One resident indicated on the comment card that they usually receive the care, support and medical attention they need. Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines within the home were flexible and the lifestyle experienced by people living there satisfied their leisure interests, religious needs and hobbies. Meals were well managed and people were helped to exercise choice and control over their lives. EVIDENCE: At Catterall House the care staff are responsible for the provision of activities, which seemed to work well at the time of the site visit. A programme of activities was in place and staff spoken to discussed what they do for residents in the way of activities and how they try to support people to maintain their leisure interests. It was noted that all the residents and their families were asked to complete a life history, detailing important life events, hobbies and interests, which could helped the home to tailor some activities to individual preferences as well as providing group activities. This was considered to be good practice Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 16 We saw those living at the home being offered a variety of choices throughout the day and it was evident that the daily routines of the home were as flexible as possible in order to suit individual needs. One resident said, ‘I can do more or less what I want here. I can get up when I want and I can go to bed when I feel like it. I can even go out for a walk whenever I want, but I do let the staff know when I am off out’. Residents spoken to confirmed that there were some activities provided for them, in the way of games, and one said, ‘I really like playing dominoes’. Others said that they were quite happy sitting in the lounge area and ‘watching the passing show’. People living at the home looked cheerful and happy in their surroundings. They were comfortable with the staff and there was a relaxed, calm atmosphere, which was pleasing to see. One resident was busy making a tapestry, which she was proud to show us, adding, ‘this keeps me going. I don’t need a lot else to keep me occupied, but I do know that some of the others enjoy playing games. I also like reading novels and newspapers’. We were told that one resident keeps his car at the home and often goes to sit in it. He does take his friend out in it when he visits the home. The resident who sent in a comment card said that there were sometimes suitable activities provided and that they usually liked the meals at the home. One resident confirmed that independence was promoted as far as possible and it was established that people were supported to be as comfortable as possible, whilst living at the home. A four weekly menu was available and although this did not show a choice of meals, residents spoken to confirmed that they could have an alternative if they preferred something that was not on the menu. Staff were seen offering people alternatives to the main menu, so that they had a choice of meals. Residents could go to the dining room or eat in their own rooms if they wanted to do so. Personal and social relationships were encouraged and religious needs were met. The meals served looked well presented and wholesome, providing residents with a nutritious and well balanced diet. The dining tables were pleasantly decorated and condiments were available, so that people could help themselves. Beverages were served during lunch and it was nice to see people being routinely offered more to eat. Staff chatted to the people living at the home in an unrushed manner about their individual interests, whilst they ate at their own pace and enjoyed a relaxed lunch time. Following the main course the sweet trolley was taken round so that people could see the wide range of desserts and choose which they wanted, which was considered to be good
Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 17 practice. The management of meals was, in general good, which was pleasing to see. Residents spoken to confirmed that the home worked to open visiting arrangements and they knew that they could entertain their family and friends in their own rooms if they wished. If they preferred they were also able to use community areas of the home to talk to visitors and relatives and friends were encouraged to participate in the various events taking place in the home. Policies seen showed that if people living at the home required an independent person to act on their behalf, then this would be arranged, so that their interests would be protected. Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living at the home were able to voice their concerns if necessary and were supported and protected by the home’s policies and procedures. EVIDENCE: The complaints procedure was widely distributed, and had a high profile within the service, so that people were fully aware of how to make a complaint, should they wish to do so. A system was in place for the recording of complaints, which was seen to be satisfactory. The resident who submitted a comment card said that they would know how to make a complaint and that the staff listen and act on what they say. However all those people who were spoken to said that they had no complaints at all about the service, but would know what to do if they were not happy about something at the home. When asked what the service does well, the registered person told us, ‘we welcome complaints, suggestions & comments from our residents, their relatives and friends. We take all complaints very seriously and respond to any complaint promptly and effectively. On our notice board it tells people how to make a complaint and there is information enclosed in our ‘Information Pack’. Robust procedures were in place in order to safeguard those living in the home from abusive situations and policies were in place so that staff were aware of their responsibility in reporting any concerns. Records showed that training had been provided for staff in relation to safeguarding adults and those spoken to
Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 19 know what to do should they have any concerns about the treatment of someone living at the home. Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment was homely and pleasant smelling. The premises were maintained to a reasonable standard, providing a comfortable place for people to live in. EVIDENCE: When asked what the service does well, the registered person told us, ‘our home is registered for twenty-four residents. All rooms are more than the recommended size and all have single occupancy. Seventeen rooms have ensuite facilities. The home provides private accommodation for each resident, which is furnished and equipped to assure comfort and privacy. The heating, lighting, water supply and ventilation of rooms meet the recommended standard. The pipe work and radiators are guarded. Emergency lighting is provided throughout the home, which is checked regularly by a qualified person. Water is stored at the recommended temperature. The premises are
Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 21 usually kept clean, hygienic and free from offensive odours’. A tour of the premises took place during this site visit. The home was clean, tidy and pleasant smelling, thereby reducing the risk of infection. Detailed infection control policies were in place and clinical waste was being disposed of in the correct manner, ensuring that people in the home were adequately protected against cross infection. One person living at the home said that the laundry service was satisfactory and that Catterall House was always kept clean and tidy. The resident who completed a comment card stated that the home is usually fresh and clean. The environment was warm and comfortable for the people living at the home, creating a homely atmosphere. The bedrooms seen were personalised with residents’ belongings, providing a homely environment for those living at the home. People spoken with told us that they were very happy with their bedrooms. The bedrooms at Catterall House are very spacious, providing people with ample space to move around, entertain friends and relatives in private and to bring their own furniture to the home if they chose to do so. One resident said, ‘I like my bedroom. It has lots of space’. One vacant bedroom was in need of some internal repair work and refurbishment before anyone lives in this room, to ensure that a good standard of accommodation is provided throughout. When asked what the service could do better the registered person told us, ‘we could actually keep a record of time spent on cleaning purposes. From time to time we do slip-back on high standard of cleanliness, hence we could do better in future. We could improve our risk assessment policy’. We were also told that improvements had been made since the last inspection by the service fulfilling all the requirements of the new fire regulations. Some carpets have been replaced and areas of the home have been redecorated, thereby providing an improved environment for those living at Catterall House. We were told that the plans for further improvement included some more of the bedrooms being redecorated and re-carpeted, which will be completed shortly. The new manager has been advised to check risk assessments for all residents, so that people are adequately protected from harm. Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The number, skill mix and experience of staff met the needs of those living at the home. People working at Catterall House had been appropriately trained and were competent to do their jobs. Residents were not consistently protected by the recruitment practices of the home. EVIDENCE: When asked what the service does well the registered person wrote on the selfassessment, ‘At the moment we only have fourteen permanent residents for which we have adequate staff .We like to think that our staff are appropriate to the assessed needs of our residents. We are also doing well for qualified staff, which is at present more that 70 having obtained a National Vocational Qualification. We do have an on going in-house training programme and there is always a senior carer on duty’. Records seen showed that all new employees were guided through an induction period, followed by an ongoing staff development programme and that 80 of care staff had achieved a recognised qualification in care, with the remaining 20 working towards this award, which is commendable. The staff rota was examined showing which staff were on duty at any one time. On the day of the site visit there were fifteen people living at Catterall House and residents spoken to felt that the staff team was appropriately meeting their
Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 23 needs. All the comments we received were very positive, showing that people were happy with the service provided. Some training courses had been provided for staff and those working at the home told us that they had received a period of induction, which was confirmed by detailed induction records. Staff were, in general, appropriately trained and competent to do their jobs. One member of staff said, ‘we have done some training, but more is planned’. It was established that moving and handling training for staff was scheduled for the day of the site visit, but this was postponed due to carpet fitting in some areas of the home. However, an alternative date had been arranged. It was pleasing to see that some staff members had completed training specific to dementia care, so that people with dementia can receive the care, which they require. Records showed that staff had completed some mandatory courses to ensure that they were appropriately trained and a number of key staff had recently completed a basic food hygiene course, to ensure that the management of meals was of a good standard, although the training certificates had not been received at the time of the site visit. The personnel records of seven people working at the home were examined. We found that, in general, the recruitment practices had improved since the last key inspection, in that, Criminal Record Bureau disclosures (CRB’s) had been obtained for all staff. However, there is still some room for further improvements in order to ensure that the procedures adopted by the home completely protect the people living there. Although appropriate checks of the Protection Of Vulnerable Adults register had been conducted before people were employed, in some instances staff were appointed before a CRB had been obtained. This is only acceptable in exceptional circumstances, in which case the registered person must be able to demonstrate that the employee has been consistently supervised until receipt of a CRB, to ensure that people living at the home are adequately protected. One overseas member of staff had only one reference on their file and a reference for another staff member was received after employment commenced. Some references had not been dated and therefore we could not determine when they had been received and some references were inappropriate as they had been written by relatives or friends of the employee. These practices do not adequately protect the people living at the home and they should be stopped immediately. Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Catterall House has a new manager who was working hard to meet the needs of the people who lived at the home, and who was trying to make sure that everyone was safe and protected by following health and safety guidelines. EVIDENCE: A new manager had been appointed at Catterall House, who had been in post for a short period of time. Therefore, Standard 31 was not fully assessed on this occasion, although it was noted that she has achieved a recognised qualification in care and is working towards a management certificate. Some audits had been conducted, which had been reviewed at regular intervals. However, this needs extending further so that the quality of service provided can be thoroughly monitored. Internal inspections were being
Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 25 conducted every month, following which a report was formulated and forwarded to the Commission as well as being retained at Catterall House. Customer satisfaction surveys had been conducted for residents and their relatives in order to obtain people’s views about the quality of service provided, the results of which were available for people to see. The system in place for monitoring the quality of service provided should now be extended to allow stakeholders within the community the opportunity to provide their views about how the home is achieving goals for residents. There was no evidence available to show that any meetings were being held at the home, so that people could get together to discuss any concerns or positive aspects of life at Catterall House and so that the management team could pass on any relevant information to interested parties. The personal allowances for residents had been thoroughly audited, which was found to be good practice so that the potential for financial errors or financial abuse was reduced. Personal allowances were retained safely and receipts were obtained for any expenditure, including hairdressing and chiropody, so that a clear audit trail was evident. Clear records showed that systems and equipment in the home were serviced at regular intervals to ensure that they were safe for use. Policies and procedures had been reviewed and updated, so that people were provided with current guidelines. A variety of internal checks had been conducted on a regular basis, showing that systems and equipment were monitored to ensure the safety of both residents and staff. Some training had been provided to ensure that staff had received sufficient guidance to enable them to do the job expected of them. Detailed policies and procedures were in place in relation to Health and Safety. When asked what the service does well the registered person told us, ‘we have only recently appointed a care-manager. She has a care qualification and has four years experience of care-assistant and senior care-assistant work. Residents do control their own money with the exception of those who cannot. We keep a record of all transactions and maintain proper records. The manager has taken the responsibility of staff’s induction, training & supervision’. Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 26 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 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X 3 Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 14(1)(a)(b) (c) Requirement The registered person must not provide accommodation to a resident at the care home unless, so far as it shall have been practicable to do so a suitably qualified or suitably trained person has assessed the needs of the resident. The registered person must obtain a copy of the assessment and the prospective resident or their relative must have been given the opportunity to be involved in the pre-admission assessment process. Care plans must be drawn up and reviewed on a regular basis, with the involvement of the resident or their relative, so that people’s needs are up dated as necessary. This issue has been raised at the last two previous inspections and must be complied with. Previous timescale 1/06/07 and 01/02/08 not met. The registered person must ensure that any hazards, which
DS0000009690.V362346.R01.S.doc Timescale for action 31/05/08 2. OP7 15(1), 15(2)(b)(c) 31/05/08 3. OP8 13(4)(c) 31/05/08
Page 28 Catterall House Version 5.2 are identified, are monitored through a risk management framework, so that people living at the home are always protected from harm. Previous time scale of 28/02/08 not met. Bedrooms 14 and 16 remain in need of repair and redecoration before anyone moves into these rooms. Previous time scale of 01/07/07 and 28/02/08 not met. Staff recruitment practices must be robust in order to protect the people living at the home. Criminal Record Bureau disclosures and two written references must be obtained in respect of each person employed, before they start working at the home, in accordance with Schedule 2 of the Care Homes Regulations. Previous timescale of 1/06/07 and 21/01/08 not met. Final timescale set as 31/05/08 4. OP24 23(2)(b) 30/06/08 5. OP29 19(1) Schedule 2 31/05/08 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 OP7 Good Practice Recommendations Clear guidance should be provided for staff so that they are aware of how to meet individual needs of people living at the home. Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 29 2. 3. 4. OP7 OP9 OP29 5. OP30 6. OP33 7. OP33 8. OP33 The care plans should be more specific so that information provided about care needs is not vague. It is recommended that any handwritten transcriptions on the medication administration records should be signed, witnessed and countersigned to confirm accuracy. The registered person should not accept references that are not authentic. It is not advisable for friends and relatives to write references for those employed by the home. The registered person should forward copies of all staff training records to the Commission once they have been received or located or when training has been completed, this includes medication training, moving and handling and food hygiene certificates. The home should extend the system for monitoring the quality of service provided by conducting regular audits on every aspect of life at Catterall House, to ensure that a good standard of service is provided for all those using it. The collation of people’s views about how the home is meeting goals for people living there should now be extended to include stakeholders in the community, who have an interest in the home. It is recommended that meetings be held periodically for residents and their relatives and for staff also so that open discussions can take place about any concerns or any relevant information, which may be of interest to people. Catterall House DS0000009690.V362346.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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