CARE HOMES FOR OLDER PEOPLE
Caythorpe Residential Home 73 High Street Caythorpe Grantham Lincs NG32 3DP Lead Inspector
Mr David Bacon Unannounced Inspection 16th January 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Caythorpe Residential Home DS0000002343.V278171.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. Caythorpe Residential Home DS0000002343.V278171.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Caythorpe Residential Home Address 73 High Street Caythorpe Grantham Lincs NG32 3DP 01400 272552 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) Mrs Christine Lyte Mrs Marion Barnes Care Home 14 Category(ies) of Dementia (7), Old age, not falling within any registration, with number other category (7) of places Caythorpe Residential Home DS0000002343.V278171.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th July 2005 Brief Description of the Service: The home is situated on the corner of main street in the village of Caythorpe, which is approximately 7 miles from Sleaford and 9 miles from Grantham. Within the village there are shops, a church and pubs. The home is currently registered to provide care and accommodation for 14 persons, 7 of which having Dementia. There are 10 single bedrooms and 2 double. There are three lounge areas and a separate dining room. A Home Care Agency operates from a separate building within the site although this did not form part of this inspection. Caythorpe Residential Home DS0000002343.V278171.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 4 hours; it was unannounced and was carried out by one inspector. A tour of the premises was conducted, service users care records and staff records were inspected along with fire and maintenance systems. The inspector spoke with the proprietor/acting manager of the home two service users, one service users representative and a District Nurse. What the service does well: What has improved since the last inspection? What they could do better:
The majority of the homes administrative systems are poorly maintained overall, which have deteriorated since the previous inspection and service users and staff are placed at risk as a result of this. Immediate requirements were placed upon the home regarding the home not having undertaken a full assessment of each service users care needs and action must be taken to fully document the care provided. Immediate requirements were also issued regarding the maintenance of care records, fire safety precautions, the overall maintenance of the home and the training of staff. It is acknowledged that the proprietor has taken over the management of the home following the previous manager leaving but these issues must be addressed. The maintenance of service users care records is poor, which places service users at risk as their needs are not adequately assessed or recorded, including health care needs. The homes care plans are basic overall and do not provide staff with sufficient information to appropriately care for service users or detail how service users needs are met. Care records are not fully updated as
Caythorpe Residential Home DS0000002343.V278171.R01.S.doc Version 5.1 Page 6 individuals care needs change and service users and their representatives are not always involved in the devising of their care plan. Insufficient training is undertaken by staff, who are not regularly formally supervised or initially inducted properly when commencing work at the home. Records regarding the maintenance or servicing of aids and adaptations or the safety of the building or equipment are not properly maintained. For example, no comprehensive electrical test had been undertaken and some service records for hoists, stair lifts, gas appliances could not be located during the visit. Fire safety equipment, testing and awareness training was not undertaken as per fire safety regulations. 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. Caythorpe Residential Home DS0000002343.V278171.R01.S.doc Version 5.1 Page 7 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 Caythorpe Residential Home DS0000002343.V278171.R01.S.doc Version 5.1 Page 8 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, 3, 4, The procedures for the assessment of service users during admission to the care home are only being partially followed, which puts service users at risk and service users cannot be assured that their care needs will be met. EVIDENCE: A statement of purpose and service users guide have been produced although these do not accurately represent the homes current provision of care. For example, regarding current management arrangements. A formal care assessment had not been undertaken for each service user. Other care records did not fully identify each service users care needs or risks or provide staff with sufficient information to meet any care needs. For example, a risk assessment had not been undertaken for one service user having significant care needs including pressure areas. Other assessment information was generally too brief or only partially completed. The care records seen did not demonstrate that service users, or their representatives where appropriate had been consulted with regarding the care plan.
Caythorpe Residential Home DS0000002343.V278171.R01.S.doc Version 5.1 Page 9 There was no written confirmation given to service users stating that the home was able to meet their care needs. Caythorpe Residential Home DS0000002343.V278171.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10, 11 Care records overall do not provide staff with sufficient information to meet service users care needs or fully document the care provided although service users feel that they are treated with respect. EVIDENCE: The service users and representative spoken with were satisfied with standards of care within the home. Comments included: “Yes, super they will help when you need it and they are approachable”. “They have been good to us, friendly, and whenever you need help you just ask”. “I have no problems with them, they look after us very well”. A care plan had not been completed for each service user and information within those inspected was brief and did not adequately document how individuals assessed care needs were to be met. A risk assessment had not been undertaken for each service user. Care records are all generally updated daily although the records seen had not been reviewed since October 2005 and there were no records of service users wishes or requests regarding bereavement. Caythorpe Residential Home DS0000002343.V278171.R01.S.doc Version 5.1 Page 11 The care plans viewed did not adequately identify service users health care needs or evidence where these were being met. For example, community nursing staff were treating one service user having pressure areas although there was no care plan information regarding this need or any action required to be taken. Caythorpe Residential Home DS0000002343.V278171.R01.S.doc Version 5.1 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 the following standard(s): 14 Service users can maintain and develop community links as they prefer although they are not fully supported to express their views regarding life within the home and the care they receive. EVIDENCE: The service users and representative spoken with confirmed that they were no restrictions as to their daily living arrangements and that staff respected their individual wishes and preferences. Service users are partially consulted with about their likes and dislikes although this is not sufficiently documented. Information regarding the homes care philosophies, which details service users rights is provided to service users although they do not have sufficient opportunity to express their views as residents meetings are not held. Caythorpe Residential Home DS0000002343.V278171.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The service users spoken with feel able to express their views regarding the care they receive and complaint guidelines are in place regarding this. Staff are provided with information regarding the homes whistle blowing policies and procedures although they must attend formal awareness training regarding this. EVIDENCE: A complaints policy is in place and one informal complaint has have been received since the previous inspection. The home has addressed this matter to the complainant’s satisfaction. An up to date copy of the Lincolnshire Adult Protection abuse awareness policies and procedures is in place although staff have not all attended formal training regarding this subject matter. The home has a whistle blowing policy, which was displayed in the office. The service users and representative spoken with said that they felt able to express their views regarding the care provided. Comments included: “Well, I would tell them without doubt, I would think that they would sort things out”. “The staff would listen, I’m sure”. “I have no complaints but yes, I feel that they would listen”. Caythorpe Residential Home DS0000002343.V278171.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24 Residents live in a clean environment and are able to make their own rooms more homely by bringing with them some of their personal belongings. EVIDENCE: The service users and representative spoken with were satisfied with the physical environment. Comments included: “I find it’s always kept clean and tidy”. “Its comfortable enough for us”. “They do keep it nice and clean and your room”. Service users personal accommodation was viewed, which was cleanly decorated and demonstrated where service users had personalised their room. Furniture is of a domestic style and is in good order. No unpleasant odours were detected during this inspection and the home was clean and tidy. Many areas have been re-decorated in the past year. Caythorpe Residential Home DS0000002343.V278171.R01.S.doc Version 5.1 Page 15 The external doors have security keypads to minimise risks to service users who may be prone to wandering. Fire safety tests were not undertaken as per fire safety regulations, which places service users at risk. There are two mobile hoists and a bath hoist although service records for these could not be located during the visit. Caythorpe Residential Home DS0000002343.V278171.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 There are sufficient numbers of staff, appropriately deployed to allow them to care for the residents although adjustments are required to be made with some of the homes recruitment procedures. The staff receive some induction when commencing work at the home although improvements must be made regarding this. EVIDENCE: The service users and representative spoken with confirmed that the homes care staff met their individual care needs. The staff records inspected did not fully document that all staff had received induction when commencing work at the home. Also, records did not fully document that all the required information had been obtained for each staff member. For example, a copy of each individual’s passport and photo was not n place and some references were not signed by the person completing them. Records of all national vocational qualification training undertaken by staff could not be located during the visit and this matter has been addressed separately. Caythorpe Residential Home DS0000002343.V278171.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 36, 38 Service users are put at risk as maintenance systems and records are poorly maintained overall. Staff are not sufficiently supervised and they must attend all statutory training. EVIDENCE: Some training is undertaken although training records were sporadic and did not fully identify that staff had attended sufficient statutory training or individuals training needs. This matter has been addressed separately. Staff have not recently received formal supervision. The homes systems and records detailing the overall maintenance of the building and equipment were poorly managed, which places service users at risk and many records could not be located during the visit. This matter was addressed separately.
Caythorpe Residential Home DS0000002343.V278171.R01.S.doc Version 5.1 Page 18 Service users meetings are not held, which would enable them to express their views regarding life within the home and quality satisfaction questionnaires are not fully utilised. Caythorpe Residential Home DS0000002343.V278171.R01.S.doc Version 5.1 Page 19 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 2 X 1 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 X 10 3 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 3 X 2 X 3 X X STAFFING Standard No Score 27 3 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X 2 X 1 Caythorpe Residential Home DS0000002343.V278171.R01.S.doc Version 5.1 Page 20 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 OP1 Regulation 4(1)(2) 5(1)(2) Requirement It is required that the statement of purpose is to include all of the items detailed within standard 1 and schedule 1 of the care home regulations and that this is made available to current and prospective service users along with a service users guide. A full needs assessment must be completed for all service users who are admitted. Care assessments must detail all items included within standard 3. A comprehensive risk assessment must be completed for each service user. A full needs assessment must be completed for all service users who are admitted. Care assessments must detail all items included within standard 3. A comprehensive risk assessment must be completed for each service user. The regisered person must confirm in writing to the service user that the home can meet the care needs. A comprehensive care plan must
DS0000002343.V278171.R01.S.doc Timescale for action 01/04/06 2 OP3 14(1)c 13(4)c 13/02/06 2 OP3 12(1)a 15(1)2 13/02/06 3 OP4 14 (1) (d) 01/04/06 4 OP7 13(4)c 13/02/06
Page 21 Caythorpe Residential Home Version 5.1 14(2) 15(1)2 5 6 OP8 OP9 13 (1) (b) 18 (c) (i) 7 8 9 OP11 OP18 OP19 4 13 (6) 23 (4) 10 11 OP19 OP22 23 (4) 23 (C) 12 OP28 18 (1) 13 OP29 19 14 OP30 12 (1) (a) be completed for each service user, which must clearly identify each service users needs and demonstrate how these are met. The plan for every service user must be reviewed each month and updated on a regular basis. Service users and their representatives (where appropriate) must be involved in the devising of care plans where possible. Service users health care needs must be met. Care staff administering medicines must receive appropriate training regarding this. Service users wishes regarding death must be recorded. All staff must attend training regarding abuse awareness. The registered manager must confirm that the home has complied with any requirements placed upon the home following the most recent Fire Officer’s inspection. Fire safety drills must be undertaken as per the Fire Safety Officers instructions Confirmation is required of the up to date servicing of the homes hoists and lifting equipment. Confirmation is required detailing what action is being taken to ensure that sufficient numbers of staff receive NVQ training. Staff recruitment procedures must be followed to ensure that any risks to service users are minimised following a CRB check being undertaken. Staff must receive a full induction to give them the skills to promote and make proper provision for the health and
DS0000002343.V278171.R01.S.doc 13/02/06 01/04/06 01/04/06 01/04/06 01/04/06 17/01/06 13/02/06 13/02/06 13/02/06 23/01/06 Caythorpe Residential Home Version 5.1 Page 22 15 16 OP31 OP14OP33 8, 9, 10 12 (2) (3) 17 OP38 18 (1) (c) (i) 18 OP38 12(1) 13(3)4 18 OP38 16jk 23(4)e welfare of service users. The home must have a registered manager. The registered person shall enable service users to make decisions regarding the care they receive. Therefore, it is required that service users meetings are offered and quality satisfaction questionnaires are provided. An action plan must be received detailing when staff will attend statutory training regarding dementia awareness, fire safety, abuse, health and safety. All of the homes equipment must be adequately serviced and records of this maintained. This must include a 5-year electrical test and test regarding legionellosis. All of the homes equipment must be adequately serviced and records of this maintained. This must include a 5-year electrical test and test regarding legionellosis. 01/04/06 01/04/06 13/02/06 13/02/06 13/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Caythorpe Residential Home DS0000002343.V278171.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Caythorpe Residential Home DS0000002343.V278171.R01.S.doc Version 5.1 Page 24 - 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!
