Inspection on 16/06/05 for Choice Care Home

This inspection was carried out on 16th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Choice Care Home 08/12/07

Choice Care Home 27/09/06

Choice Care Home 04/10/05

Choice Care Home 22/02/05

Choice Care Home 25/05/04

Choice Care Home 15/01/04

Choice Care Home 16/07/03

Choice Care Home 06/08/02

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Choice Cary Avenue Babbacombe Torquay TQ1 3QT Lead Inspector Michelle Finniear Announced 16 June 2005 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Choice D54-D07 S18337 Choice V223112 160605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Choice Address Cary Avenue, Babbacombe, Torquay, TQ1 3QT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01803 327828 01803 403026 Rosepost Healthcare Ltd Mrs Sandra Cowley Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24), of places Physical disability over 65 years of age (24) Choice D54-D07 S18337 Choice V223112 160605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22/2/05 Brief Description of the Service: Choice care home offers accommodation with personal care to older people (65 ), older people with physical disability and older people with dementia. It is registered to provide a service for up to 24 residents both male and female. The home is laid out over 3 levels ground, mezzanine and first floor. The mezzanine and first floors can be accessed by stair lifts. Choice offers 18 single bedrooms, 17 of which have en suite facilities and 3 double bedrooms, 2 of which are en suite. In terms of communal space, the home offers a large lounge, 2 conservatories, a dining room and a pleasant fully accessible garden. It also has communal bathrooms and toilets. Choice is a large detached property set in its own grounds. It is located in the residential area of St. Marychurch and is close to local shops and Babbacombe downs. Torquay town centre is approx one and a half miles from the home. Choice D54-D07 S18337 Choice V223112 160605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced, and took place over one day of 7 hours in June 2005. Before the inspection the homeowner completed a pre-inspection questionnaire. This inspection was carried out by two inspectors, one of whom was a specialist pharmacy inspector. The pharmacy inspector spent several hours with the manager of the home examining in detail the homes medication administration and storage systems. To complete the inspection a tour was made of the premises, seven service users and two relatives were spoken to, paperwork and records examined and discussions held with staff and management. What the service does well: Choice has an established team of staff, who work well in meeting the needs of the service user group. Staff receive training relevant to their work, and many have undertaken NVQ qualifications. Staff were positive and advocated strongly for service users. Evidence of good relationships between the owners, staff and service users/relatives was highlighted particularly in the care, respect and consideration given to one service user and their relatives during a life limiting illness. Meals are wholesome and nutritious, home-cooked and were enjoyed by residents. The home has benefited from a programme of redecoration, and communal areas are comfortable and homely. All areas of the home seen were clean and free from significant odour. There were some good systems for medicine management implemented within the home. Choice D54-D07 S18337 Choice V223112 160605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: 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. Choice D54-D07 S18337 Choice V223112 160605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Choice D54-D07 S18337 Choice V223112 160605 Stage 4.doc Version 1.30 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 standard(s) 1,2,3,4,5,6 Choice provides good, clear information to potential residents, to enable them to make a decision about whether the home is the right place for them before they move in. EVIDENCE: Choice has a statement of purpose and a service user guide, which includes information about every aspect of the home, and is given to each person who lives at the home as well as people planning to move in. The admission process that had been followed was examined for two recently admitted service users, one who had been admitted following several respite care stays and another admitted from a local intermediate care centre. In both instances the homes admission process had been followed appropriately, with full assessments being undertaken by social services, or by the home itself, to ensure that the home was capable of meeting the service user needs. These assessments included abilities, interests and physical care needs required, which were mirrored in the care plan. This means that service users care and social needs were being identified and met. Choice’s ability to meet the needs Choice D54-D07 S18337 Choice V223112 160605 Stage 4.doc Version 1.30 Page 9 of service users was confirmed in writing prior to admission, along with information on the contractual arrangements, so that all parties were aware of the fees to be paid and what services were to be provided for the fee. In discussion three service users confirmed they had been involved in the process of choosing the home, including visiting the home wherever possible, or had support from relatives in doing so. The home does not provide intermediate care, although does provide respite care when space is available. Choice D54-D07 S18337 Choice V223112 160605 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11 Residents living at choice are well supported by staff and other professional agencies in meeting their health, personal and social care needs. Medicine Records must be fully completed to provide complete audit trail. The storage, storage temperature and working space for handling medicines were inadequate. EVIDENCE: Each resident at Choice has an individual up to date plan of care, based upon regularly updated assessments. This means that all service users needs have been identified so that staff can ensure they are working consistently to give the person the care they need in a way that reflects their wishes. Care plans for five residents were seen, elements of which were subsequently related to the individual resident and were found to be an accurate reflection of their needs. Plans have been revised since the last inspection, and would benefit from further person centred planning. The home has excellent support from local medical and district nursing services, including community psychiatric nurses. Evidence was seen and Choice D54-D07 S18337 Choice V223112 160605 Stage 4.doc Version 1.30 Page 11 heard of district nursing input to give specialist care, which the home would not be able to give, take blood, and manage complex dressings. As a part of this inspection, The Commission for Social Care Inspection Pharmacy Inspector made a full inspection of the homes medication practices. The majority of audits undertaken demonstrated that medicines were administered as prescribed and a good Kardex system implemented. However Medicine Administration Records (MAR) system were not robust enough with some MAR charts containing insufficient details such as, allergies, date when medicines received, forward stock balances onto current MAR charts, accurate copying of medication details on to handwritten MAR charts and crossings out. Changeover medicines were stored in a cupboard with main central heating pipes. The written policy did not have details of policy date, signature, review date, supplying pharmacy, out of hours pharmacy, GP’s, ordering of prescriptions, and reporting to the CSCI in the event of serious medication error. Staff were not aware of The Administration and Control of Medicine guidelines by the Royal Pharmaceutical Society of Great Britain. Controlled Drugs (CD) were stored inadequately in a bolted cash tin in a cupboard, however the CD register was in order. Several medicines, skin cleansers and antiseptics were found out of date in the cupboard. Arrangements for health and personal care for service users seen respected their privacy and dignity with regards to personal care, bathing, washing, and using the toilets. Screens are available in shared rooms, and the majority of rooms have ensuite facilities, including baths in many cases. Bedroom doors have locks fitted which can ensure service users can lock their room when they leave, or lock their room while they in it to maintain their privacy. During the course of the inspection, one service user was extremely unwell and the care offered to this service user and their family was commendable. Their spouse had been enabled to spend the previous night with them in their room, and meals and support was given throughout this extended and distressing period. The spouse of the terminally ill service user commented that the home could not have done more to care for their partner, and evidence was seen of the genuine care and respect displayed by the homes staff. Choice D54-D07 S18337 Choice V223112 160605 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: Choice has a dedicated cook and a series of menus, developed in consultation with service users reflecting their wishes and choices. Menus are changed seasonally and discussion with service users indicated their satisfaction with the food served both in quantity and quality. Two service users commented that the evening meals were not always to their taste, but confirmed that options were always available if they did not like the meal being served. Service users had fruit and biscuits in their rooms, and those spoken to confirmed they were able to eat their meals in the dining room or in their rooms as they wished. Some service users were receiving meal supplementation, and evidence of this was seen in care plans and in the homes office. This means that the home ensures that service users with eating difficulties or poor appetite still received adequate nutrition. During the afternoon of the inspection an organist was entertaining service users in the lounge. Choice D54-D07 S18337 Choice V223112 160605 Stage 4.doc Version 1.30 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 standard(s) Choice has a satisfactory complaints system, which ensures service users have opportunities to air their views. Arrangements for protecting service users from abuse and neglect are satisfactory. EVIDENCE: The home has a complaints procedure, issued to all service users and on display within the home. The complaints procedure makes it clear how and to whom to make a complaint, and gives information on timescales for responses. Since the last inspection a complaint was received in relation to the discharge of a service user. This appears to be an issue with communication, and is being resolved at the time of the report. Choice D54-D07 S18337 Choice V223112 160605 Stage 4.doc Version 1.30 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 standard(s) 19,20,21,22,23,24,25,26 Choice provides a safe, comfortable, and homely yet adapted environment for older people. EVIDENCE: The program of investment in the decor and environment of the home undertaken since last inspection has made significant improvements to the appearance of the homes communal areas, and this is to be further extended with alterations to the homes office to provide a new assisted bathroom, improved disabled access toilet, and new office/clinical space. This will enhance facilities for service users with mobility problems. Additional work is planned to upgrade the existing bathroom facilities. Since the last inspection all hot surfaces accessible to service users have been protected. This means service users are now fully protected from the risk of scalding or burns from over hot radiators or baths. The home has three rooms for shared occupancy, all others being single, and a variety of communal space. The home has good parking facilities, and onChoice D54-D07 S18337 Choice V223112 160605 Stage 4.doc Version 1.30 Page 15 street parking is freely available outside. There is a private and attractive garden to the rear of the home, visible from many bedrooms and the conservatory, so residents have access to sheltered seating and outside space. The Fire Officer last visited in July 2004, and the environmental health officer on the 13th of April 2005. Services such as gas boilers, central heating and stair lifts are all on maintenance contracts, evidence of which were seen during the inspection. The home has automatic water temperature regulation, which is regularly calibrated, and a new electrical wiring certificate has been issued in December 2004. All electrical appliances brought into the home are tested for electrical safety, and routine test certificates were inspected. This means service users are being well protected in the home from these potential hazards. A tour was made of the home during the course of this inspection, and all unlocked service user rooms were inspected. Service user rooms varied in size and shape, and showed evidence of the personality of the occupant. Many service users had bought items of personal belongings into the home with them, including some items of furniture, photographs etc. All residents rooms had televisions, the majority with en-suite facilities and views over Cary Park or the homes garden. There is a choice of communal areas, including a large lounge and separate conservatory, so service users have a choice of where to sit. All areas seen were free from significant odour, and were clean, warm and comfortable. The kitchen has been refitted to professional standards since the last inspection, and a new washing machine and dryer installed in the basement laundry, a long with a laundry chute to ensure soiled linen is not carried to a areas where food is stored. This will reduce the risk of infection and ensure good standards of laundering for service users clothes and bedding. Choice D54-D07 S18337 Choice V223112 160605 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29, 30 The home has a consistent staff team, with well trained staff who work well together to ensure service users needs are met. EVIDENCE: An examination was made of staff rotas both for the week of the inspection and for the preceding weeks. These confirmed that staffing levels are maintained at 4 care staff in the morning, 3 in the afternoon and two waking night staff between 8pm and 8 am. In addition the homes owners Mr and Mrs Owen work at the home daily, as does the registered manager, who works several shifts as a carer. There are two cleaners and two cooks. These staffing levels should ensure that service users receive the level of care that they need. Service users spoken to confirmed that staff were very kind and worked hard “ lovely staff and caring but very busy were typical comments. Few shifts have been covered by agency workers, and the home has appropriate protocols for ensuring that appropriate recruitment processes including criminal records bureau checks have been undertaken by the supplying agency. This should ensure service users are protected. The home has a comprehensive staff recruitment process, which was outlined by the registered owner. Four staff files were selected at random and found to contain generally all required information, however one files selected only contained one reference. No volunteers are employed. All staff files seen contained evidence of criminal records bureau checks having been undertaken, and evidence that the General social care Council codes of conduct have been Choice D54-D07 S18337 Choice V223112 160605 Stage 4.doc Version 1.30 Page 17 given to all staff. This means that service users are being protected through robust recruitment procedures. The registered manager of the home is an enrolled nurse, and has completed her NVQ 4 in management. She is to undertake an additional two units to complete her registered managers award. Significant numbers of staff at the home have completed or are undertaking their NVQ assessments, and the owner confirmed that approximately 90 of the staff group will have an NVQ qualification if there is no alteration to the staff group. This exceeds the National minimum standard and is commendable. One member of staff has commenced her NVQ 4 and others are undertaking or are commencing level 3, including night staff. This means service users are being cared for by staff who are trained and qualified. Evidence of staff qualification was seen in files, including individual training and development profiles. Core training in food hygiene, fire prevention, infection control and first aid could also be evidenced, along with completed induction training plans. The home has been re-accredited for the Investors in People Award, which is commendable. Choice D54-D07 S18337 Choice V223112 160605 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,38 Issues of health, safety and welfare are being addressed, and the management approach of the home ensures service users interests are safeguarded. EVIDENCE: The home could demonstrate a developing Quality assurance and quality monitoring programme, based on a series of questionnaires issued to staff and service users. These are to be extended to additional stakeholders such as district nurses and general practitioners as well as relatives of service users to ensure that a variety of perspectives are obtained as to the operation of the home. This means that service users and relatives have a say in the running of the home. The home has achieved the Investors in People Award. Service users should benefit from a quality assurance/monitoring programme that encourages and acknowledges a range of views on the operation of the home and influences future planning and development. Choice D54-D07 S18337 Choice V223112 160605 Stage 4.doc Version 1.30 Page 19 Evidence was seen of the health and safety arrangements made by the home. This included risk assessments of safe working practices and moving and handling tasks (03/05), training certificates in food hygiene, first aid, infection control and fire prevention, servicing of electrical equipment and heating systems, monitoring of water and hot surface temperatures and protection, testing for Legionella, visual evidence of window opening restriction, security lighting and the recording and analysis of accidents and incidents. Training was last given to all staff in health and safety in March 2005. Moving and handling plans should be developed for service users based on the assessments provided, and some COSHH data sheets were missing. This would mean not all chemicals in use had information available in case of ingestion or accident, which might put a service user or staff member at risk. Choice D54-D07 S18337 Choice V223112 160605 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x 3 x x x x 2 Choice D54-D07 S18337 Choice V223112 160605 Stage 4.doc Version 1.30 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard 29 9 9 Regulation 17 13(2) 13(2) Timescale for action Two references must be obtained 23/6/05 for each member of staff employed. The medication policy needs to 30/9/05 be reviewed to ensure this covers procedures suggested The manager or designated 17/7/05 person must see the original prescription forms to check them against the items that were ordered before they are submitted to the pharmacy. A copy or reference to the original prescriptions must be retained on the premises There must be sufficient room to 30/9/05 store nutritional supplements, including prescribed dressings, cleansing solutions and antiseptics. Medicines stored and during the Immeidate change over period when new and supplies are received from the ongoing pharmacy must be maintained at a temperature appropriate for medicine storage. To provide a CD cabinet for 30/9/05 storage of Controlled Drugs, which meet the requirements of the Misuse of Drugs (Safe Custody) Regulation 1973 Version 1.30 Page 22 Requirement 4. 9 13(2) 5. 9 13(2) 6. 9 13(2) Choice D54-D07 S18337 Choice V223112 160605 Stage 4.doc 7. 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. Refer to Standard 38 7 9 Good Practice Recommendations COSHH data sheets should be obtained for all cleaning or chemical products in use. The home should increase the amount of person centred planning in the service user care plans. It was noted that some Mar Charts were hand-written. It is strongly recommended that these be accurately copied, checked by a second person, signed, dated and referenced back to the original prescription It strongly recommended that staff read the patient Information leaflets kept in a file for the provision of up to date information on storage of medicines kept in the home. 4. 9 Choice D54-D07 S18337 Choice V223112 160605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Choice D54-D07 S18337 Choice V223112 160605 Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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