CARE HOMES FOR OLDER PEOPLE
Catterall House Lancaster New Road Catterall Lancashire PR3 0QA Lead Inspector
Mrs Christine Marshall Unannounced Inspection 10:00 30th May 2006 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.V292398.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 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 Mrs Maureen Margaret Stobbart Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 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 19th October 2005 Date of last inspection Brief Description of the Service: Catterall House is a large, old, house situated on a main road in a rural area, within walking distance of local shops, and a short drive from Garstang. It is also on a bus route. The home has been adapted to suit the needs of older people, for example, a passenger lift has been installed and ramps fitted to entrances. There is adequate car parking space to the side of the house. It is a two-storey house with single bedrooms on the ground and first floor; there is one double bedroom. Most bedrooms are now furnished to a satisfactory standard, with the remaining currently being refurbished. There are adequate toilets and bathrooms, with the main bathroom having a bath hoist. The home provides sufficient communal space, and there is a separate smokers lounge. Carers are at the home 24 hours, every day of the year. The most recent inspection report is available from the manager. At the time of this visit, (30/5/06) the information given to the Commission showed that the fees for care at the home are from £299 to £350.50 per week, with added expenses for hairdressing, chiropody and newspapers. The registered provider is Dr Varsha Ramesh and the registered manager is Mrs Maureen Stobbart. Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the first of two unannounced inspection visits, scheduled from 1st April 2006 to 31st March 2007. All of the people spoken to and who were able at the home said that they preferred to be called residents. This unannounced inspection took place over a full day and was carried out by the home’s designated lead inspector Christine Marshall. A tour of the home included bedrooms, lounge and dining areas, and bathrooms. All areas were clean and hygienic and most were satisfactorily furnished: Administration records were also examined. The manager completed a pre-inspection questionnaire before this key inspection visit and comment cards were received from residents, relatives and visiting professionals. The manager and care staff were spoken to and all of these responses are to be found in the body of this report. Everyone was very friendly, welcoming and co-operative throughout the visit. What the service does well:
There is a consistent staff team, with a good mix of long-term and experienced, and young and enthusiastic care staff, both male and female. The manager is now registered with the Commission for Social Care Inspection and is approachable and responsive, and keen to continue to raise standards in the home. One resident commented, “She (the manager) is outstanding.” And another said, “I can’t fault her (the manager), she is very caring.”
Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 Page 6 Other residents said, “The food is good and I can have a drink at any time of the day or night.” And “We get a good choice of dinners, especially the puddings.” There are good written records of care in place and the manager is in the process of updating and reviewing these very regularly. There is equality of care for all residents in that each is given very individual care according to their needs, and the outings and activities at the home take into consideration their particular likes and dislikes. What has improved since the last inspection? What they could do better:
The medication policy does not reflect the procedures carried out in the home and this means that the ordering, administering, storing and returning of medications may not be carried out properly and with the safety of the residents in mind. This was identified as an issue during the last inspection visit and must be addressed as a matter of priority. Although there is a formal system of quality monitoring in place, (Investors in People) and there is a survey sent to all residents who have used the home’s services, the result of these are not made available for residents and their relatives or visiting professionals to see. To make sure that equality of opportunity is given to all residents, a regular quality survey must be sent to all residents and their relatives, as well as visiting professionals; the results of this survey should then be made available to them, for information and comments. Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 Page 7 The policies and procedures for the management and administration of the home must be reviewed annually to make sure that the home’s practices are up to date and properly servicing the needs of the residents. Staff supervision has just been started and should be recorded six times a year. This makes sure that the people working at the home are giving the care that is of the right standard for the residents. The fire safety department have recently made a visit to the home and found that there were a number of serious issues that needed to be put right. The fire officer has given advice and guidance to the home and also made a number of requirements in line with fire regulations; these must be attended to within the timescales given. 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. Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Anyone who is considering entering Catterall House is supplied with enough information to help them make that decision. The home also basically gathers enough information about that person to ensure that their needs can be met. This means that people can make good choices and receive the care they require. EVIDENCE: The home’s Statement of Purpose and Service Users Guide is a set of written information that tells you about the care service that is offered, who the manager and staff are, and what the resident can expect if he or she decides to live at the home. This has recently been reviewed and updated. Some residents and a relative said that they knew about this information. Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 Page 10 The two carers on duty said that knew about the Service Users Guide and Statement of Purpose, and were able to describe what was in this information. This means that they were clear about the provision of care that they were giving to the residents. Pre-admission assessments were looked at and were completed satisfactorily, however they are in need of a review to include all aspects of care as described in the National Minimum Standard number3. Contracts of care were also in place and signed by either the resident or their advocates. This means that residents know what to expect from the home and what is expected of them. Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents health and social care needs are mostly met and people are treated with dignity and respect at this home. Residents are mostly supported and protected in their daily lives. EVIDENCE: Care plans are written records that describe the care that is given to each resident. These were looked at and all but one of them were reviewed and updated. The senior carere on duty said that they knew about the care plans and that these generally reflected the care that was being given to each person. Two residents were able to say that they knew about their care plans. It is recommended that each plan of care be signed by the resident or their relatives.
Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 Page 12 Health care opportunities are offered to all residents and there are records of GP, chiropody and physiotherapy visits. The medication system at the home has been changed and is now a monitored dosage system (MDS). Records were satisfactory but the home’s policy and procedure for medications had not been updated to reflect the new system. General advice was given about storing creams and medications in the fridge and the recording of medication fridge and treatment room temperatures. This will make sure that creams and lotions are stored at the right temperature. The residents were treated with respect, privacy and dignity, and there was a good personal interaction between resident and carer. The residents who were able and a visiting relative said that they were happy with the care given at the home. Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents throughout the home are supported so as to promote the quality of their daily lives. EVIDENCE: There were records of activities programmes for the residents that included bingo, video, manicures, arts and crafts and outings. The activities programme at the home could be improved if the carer leading the programme was given extra hours to devote her time to this very important part of residents’ care. All residents are treated equally in that they were offered activities, therapies and outings, regardless of their level of understanding or mobility. Some residents were able to say that they enjoyed the activities. All residents seem to be supported in their contact with the community, although this is limited for those suffering with memory loss or confusion.
Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 Page 14 One resident is very independent and goes out daily to visit a relative; he/she is fully supported and encouraged to maintain his/her independence. Two visiting relatives said that they were welcomed at any time to the home and always offered refreshments. The home provides meal choices, a nice dining area and unhurried mealtime routines. Presently there are no soft or pureed diets needed, but these can be provided if necessary. The lunchtime meal was presented in an appetising way and when sampled, tasted very good. The residents generally said that the food was good and that they had choices and good portions. The cook prepares the menus weekly, taking into account the preferences of the residents and drinks and snacks were available at any time. Diabetic and vegetarian diets are catered for thus providing equality of choice for all residents. Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s policies, procedures and practice make sure that residents are supported and protected. EVIDENCE: There are policies and procedures in place for complaints, whistle-blowing and adult abuse issues, and staff said that they were aware of these. Residents who were able and one visiting relative confirmed that they knew about the complaints policy and had no complaints to offer. There have been no complaints since the previous inspection visit. Training files showed that all staff have had abuse awareness training on induction to the home, however the manager agreed that a more formal training package for abuse awareness would improve the staff’s understanding of these issues. She (the manager) is going to arrange this in the near future Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are provided with a comfortable, clean and hygienic environment and bedrooms were personalised. This means that residents will feel at home with their belongings around them. EVIDENCE: A tour of the home showed that the general environment was very much improved; most of the bedrooms had been redecorated; the lounge and dining room had been decorated and furnishings were comfortable. Bedrooms are personalised and comfortable and three residents were able to say that they were happy with their room. Visiting relatives said that they were happy with the standards of cleanliness at the home and comments cards that were received agreed with this.
Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 Page 17 There are aids and adaptations are in place to help with the residents’ mobility, personal toilet and bathing needs. However the main bathroom with mobility aid must be refurbished and redecorated so that the residents can have a pleasant and comfortable bathing time. The laundry area was clean and hygienic. Although there is not a written refurbishment programme for the home, the painter and decorator was busy working in two bedrooms on the day of this inspection and said that he had been commissioned to redecorate all of the bedrooms in the house. Some bedrooms are decorated but need to have the vanity units covered and pipes boxed in. One bedroom is decorated but has water marks on the outer wall. Generally the lounge and dining room carpets were in need of cleaning and the carpets in the corridor by rooms 11 and 12 need replacing, as they are worn and rather shabby. Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected through good recruitment procedures and adequate staffing levels meet the residents needs. EVIDENCE: The duty rotas showed that there were adequate staff on duty to take care of the residents at the home. Staff provision includes male, female and overseas personelle, showing that there is equality of opportunity at this home. The level of care staff with National Vocational Qualifications (NVQ) at the home were 80 which is above the required 50 and therefore very good indeed. All records that were examined in the staff recruitment files were satisfactory and staff siad that they had undergone all of the employment checks before starting work at the home. All staff training records that were examined showed that induction and training and the mandatory health and safety training programmes were in in place. Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 Page 19 Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The residents are supported by an new and enthusiastic manager and there are quality systems in place to make sure that they are protected. However there are fire regulation issues that affect the safety of the residents in the home. EVIDENCE: The manager is qualified to NVQ level 3 and is presently doing the Registered Managers Award course. The residents said that she was very approachable, kind and understanding and seen around the home throoughout the day.
Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 Page 21 The Investors in People (IIP) quality monitoring system is in place and the manager is going to send out an annual quality surevey to residents and relatives and visitng professional; the results of this will be put on the notice board for information and comments. There are regular staff meetings and the careres confirmed that they had these meetings. Records of residents personal monies that are kept at the home and when sampled proved accurate and the monies correct. Staff supervision programmes are in place, but these need to be recorded six times a year. Advice was given to the manager about the types of supervision and how to record these. The manager was aware of the responsibilities of maintaining all health and safety certificates of service for fire, equipment, electric, gas and nurse call systems. The quality outcome for these standards would have been good; however the Fire Safety Department had recently visited the home and found there to be a number of serious issues about fire protection within the environment and some of the furnishings. A series of requirements have been made by the fire officer, with deadlines for action and these must be adhered to for the protection of the residents who live in the home. Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 Page 22 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 3 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 2 2 3 2 3 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 1 Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 Page 23 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 OP3 Regulation 14 Requirement Pre-admission assessments must include all aspects of care as per National Minimum Standard 3 guidelines. The medication policy must reflect the procedures carried out in the home (Previous timescales of May 2005 and November 2005 not met) All staff must have formal abuse awareness training. The carpets in the corridor near bedrooms 11 and 12 must be replaced. The main bathroom with hoist must be fully refurbished and redecorated. All bedrooms and communal areas must be redecorated and refurbished. The manager must complete the Registered managers Award (or equivalent). A formal system must be in place to review the quality of care provided at the home with regular consultation with
DS0000009690.V292398.R01.S.doc Timescale for action 10/07/06 2 OP9 13 10/07/06 3. 4. 5. 6, OP18 OP19 OP21 OP24 18 23 23 23 01/11/06 01/09/06 01/09/06 01/09/06 7. 8. OP31 OP33 10 24 31/03/07 10/07/06 Catterall House Version 5.1 Page 24 residents and their representatives. The results must be made available to them. Policies and procedures must be reviewed annually. (Previous timescales of May 2005 and December 2005 not met) 8. 9. OP36 OP38 18 13 All staff must have formal 01/11/06 supervision and associated written records of this. Fire regulations must be adhered 01/05/07 to and any requirements that are made by the Fire Safety department must be attended to and abided by. Various timescales have been given by the Fire Safety Dept. 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. 3 4 Refer to Standard OP7 OP9 OP12 OP26 Good Practice Recommendations All care plans should be fully reviewed on a monthly basis and should be signed by the resident or their relatives. The medication fridge and treatment room should have the temperatures recorded daily. Dedicated time to organise the activities programme should be given to a named person at the home. 4 hours is recommended. The carpets in the lounge and dining areas should be cleaned. Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© 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 Catterall House DS0000009690.V292398.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
