CARE HOMES FOR OLDER PEOPLE
Choice Cary Avenue Babbacombe Torquay TQ1 3QT Lead Inspector
Michelle Finniear Unannounced 4 October 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 V241936 041005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Choice Address Cary Avenue, Babbacombe, Torquay, Devon, 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 V241936 041005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 16/6/05 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 V241936 041005 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced, which means that neither the proprietor or the service users were given notice of the date or time of the visit. The inspection took place over 5 hours in October 2005. To complete the inspection a tour was made of the premises, eight service users and five members of staff were spoken to, some paperwork and records were examined and discussions were held with the homes management. What the service does well: What has improved since the last inspection?
Since the last inspection the home has reviewed their policies and procedures on medication, and is now copying the original prescription forms before sending them to the pharmacy. Medication is stored at correct temperatures. This means service users are better protected from potential errors with their medication. The home is due to provide an altered office/bathroom in the next month which will provide sufficient room to store nutritional supplements, including prescribed dressings, cleaning solutions and antiseptics, and a new controlled drugs cabinet. This will increase the security of medications at the home. A new file has been set up to include data sheets on all cleaning or chemical products in use. This means that the home now has information to hand on the
Choice D54-D07 S18337 Choice V241936 041005 Stage 4.doc Version 1.40 Page 6 risks presented by cleaning materials such as toilet cleaner, and what to do in case of the accidental misuse of any of the chemicals in use at the home. The home manager has been doing work on the person centred planning in the service user plans. This means plans will better reflect the individual needs and wishes of the people living at Choice. 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 V241936 041005 Stage 4.doc Version 1.40 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 V241936 041005 Stage 4.doc Version 1.40 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) 3 A full pre-assessment procedure is followed prior to any admission to the home. EVIDENCE: One new service user was due to be admitted to the home in the days following the inspection. Pre-admission information was available to detail the assessments and visits that had been undertaken to determine whether Choice was the appropriate placement for this service user. The process that had been followed had included the service user visiting the home and taking photographs of the potential accommodation available, the obtaining of a thorough assessment from the specialist unit this potential service user had previously been in, the home completing their own assessment, and the redecoration and refurbishment of the chosen room in preparation for the admission. Pre-admission assessments are important in determining whether the home is the right placement for the service user, and from the perspective of the service user whether the home is the right place for them. Choice D54-D07 S18337 Choice V241936 041005 Stage 4.doc Version 1.40 Page 9 Discussion was held with another service user who had been admitted to the home within the last month. They confirmed that they had been supported by Social Services in making a decision to move into the home. They were given pre-admission information about the services and facilities they could expect to receive, which supported them in making the decision. Choice D54-D07 S18337 Choice V241936 041005 Stage 4.doc Version 1.40 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 Service users living at choice are supported by staff and other professional agencies in meeting their health, personal and social care needs. EVIDENCE: Service user plans for four service users were selected at random. Plans were discussed with the proprietor, and subsequently referred to the service users concerned. Plans gave an accurate a picture of the care given to the service uses concerned. Plans are important in ensuring that service users needs are assessed and met consistently, and that any changes in need can be quickly assess and communicated throughout the staff group. In particular one Plan was discussed extensively with a service user who had recently come to the home. The service user was able to confirm that the care needs identified in the plan, including the process of supporting the service user in mobilising, were what happened in practice, and met their care needs. They had been consulted on the development of the plan, which is important in ensuring that care is delivered in the way that service users request. Other records kept at the home include a daily record in a Kardex system. This daily log indicated that the service user was attended to on several occasions
Choice D54-D07 S18337 Choice V241936 041005 Stage 4.doc Version 1.40 Page 11 throughout the night, and the service user was again able to confirm that this was the case. Medical notes indicated when a regular blood test had last been taken, and this was confirmed again by the service user. This indicates that plans are maintained accurately, and reviewed regularly. The home is understood to have reviewed the medication policies since the last inspection. Prescriptions are now photocopied so that the home has original prescription forms to check against items ordered before being submitted to the pharmacy. Alterations are due to occur in the near future to the office area which will then provide a more appropriate system for the storage of medication at the home stop this will incorporate sufficient room to store nutritional supplements, prescribed dressings, cleaning solutions and antiseptics as well as fitting the new controlled drugs cabinet which has been purchased. This will mean that medication is stored and administered to service users with greater safety, minimising any potential risk of error. One service user was very frail and was being cared for in bed. A specialist bed had been supplied from the District Nursing service, and this included equipment for pressure area care. Choice D54-D07 S18337 Choice V241936 041005 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, Opportunities to meet daily lifestyle choices and social activities are provided. EVIDENCE: Service users interviewed at the home varied considerably in their needs and wishes for activity and participation in life outside of the home. Some were able to go out independently, others required full care and support to carry out tasks of daily living. The home has a lounge and large conservatory, which were well used during the day. One lounge had music on during the course of the inspection, whilst in the other service users were chatting. Service users in other areas of the building were watching television, reading newspapers or in one case writing a letter. Discussion was held on organised activities at the home. Activities are regularly provided, such as musical afternoons, cookery, games and keep fit. The admission process takes account of hobbies and interests, but few service users have identified areas they now wish to continue. One service user requested individual time be provided to assist in the writing of letters and Christmas cards.
Choice D54-D07 S18337 Choice V241936 041005 Stage 4.doc Version 1.40 Page 13 The home recently held a coffee morning for cancer relief, in which service users and staff participated, and significant dates and events throughout the year are celebrated or acknowledged. Visitors are welcomed to the home and service users confirmed this. This supports service users ability to remain as a part of the community. Service users are encouraged to maintain their independence and exercise control over their lives for as long as possible, and this relates both to handling their own financial affairs, bringing personal possessions into the home with them and the provision of information where required on how to contact external agencies for support, for example advocates or legal advice. Service users have access to personal records in accordance with the Data Protection Act 1998. However discussion with two service users indicated they had no wish to see records held on them. The home has a varied menu of home-cooked food available. On the day of the inspection the main meal being provided was shepherds pie and vegetables, with jam tarts and custard for dessert by special request. Choice D54-D07 S18337 Choice V241936 041005 Stage 4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Choice has a satisfactory complaints system, which ensures service users have opportunities to air their views. EVIDENCE: No complaints had been received since the last inspection at the time of this inspection. 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. Choice D54-D07 S18337 Choice V241936 041005 Stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,22,25,26 Choice provides a safe, comfortable, and homely yet adapted environment for older people. EVIDENCE: 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, which helps the home feel more their own. All residents rooms, except one for respite room had televisions, the majority also having en-suite facilities, affording better privacy, 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. This means service users can live in comfortable and hygienic surroundings.
Choice D54-D07 S18337 Choice V241936 041005 Stage 4.doc Version 1.40 Page 16 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 onstreet 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. These agencies produce a report to the home indicating any areas requiring attention, increasing safety for service users. At the time of the inspection alterations were due 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. In the coming year it is planned to re-roof the building and redecorate externally, which will ensure service users live in a well maintained and attractive envrionment. One service user requested increased lighting facilities in their room and it is recommended that one low window has replacement safety glass fitted or has a safety film fitted to ensure that the service user would be kept safe from glass breaking if they were to fall against the window. The owner has previously confirmed that all the water supply to service user areas is automatically regulated to a maximum temperature of 43 degrees centigrade. The water temperature to one wash hand basin tested was in excess of this figure and must be recalibrated. This is to ensure that service users are protected from the risks of scalding. One service user requested a phone line be installed to their room which was raised with the provider for action. Choice D54-D07 S18337 Choice V241936 041005 Stage 4.doc Version 1.40 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The home has a consistent staff team, with well trained staff who work well together to ensure service users needs are met. EVIDENCE: On the day of this unannounced inspection the care staffing levels on duty met the needs of the service user group and support staff such as cleaners and catering staff were also available. Service users interviewed were complimentary about the staff with such comments as “They’re looking after me very well indeed” and “extremely kind and helpful – nothing is too much trouble”. Discussions were held with staff informally at their coffee break as well as while carrying out their duties. Staff interviewed were clear about the care they were giving and their role in the protection of vulnerable people, and discussions were held over the civil rights of service users, NVQ’s and the role of CSCI. At the previous inspection staff files were examined and found not to contain all the required information on their employment. At this inspection one new member of staff has been appointed and commenced a trial shift under supervision. Records such as references and a criminal records bureau check
Choice D54-D07 S18337 Choice V241936 041005 Stage 4.doc Version 1.40 Page 18 have been applied for but had not yet been received. Full staff records are important in ensuring that service users are only cared for by people who are suitable to care for potentially vulnerable people. Choice D54-D07 S18337 Choice V241936 041005 Stage 4.doc Version 1.40 Page 19 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) 35, Service users financial interests are safeguarded. EVIDENCE: Service users are encouraged to handle their own financial affairs with the support of the family wherever possible. For four service users the home holds a small float of cash to deal with day to day expenses such as chiropody and hairdressing, as they are unable or do not want to deal with this aspect themselves. Individual expenditure is receipted and the amounts of money held were tallied with the accounts in use and found to be correct. The provider is not an appointee for any service users for Benefits purposes. No possessions have been handed to the home for safekeeping and the home has secure facilities for the storage of money and valuables. In addition each service user has an item of lockable storage in their rooms which means service users can keep small items or documents privately and securely.
Choice D54-D07 S18337 Choice V241936 041005 Stage 4.doc Version 1.40 Page 20 Choice D54-D07 S18337 Choice V241936 041005 Stage 4.doc Version 1.40 Page 21 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 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 2 3 x 3 x x 2 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x 3 x x x Choice D54-D07 S18337 Choice V241936 041005 Stage 4.doc Version 1.40 Page 22 YES 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 OP25 Regulation 13 Requirement Ensure water temperature at the point of delivery to all service user accessible wash hand basins does not exceed 43 degrees centigrade The glass in the identified window should be replaced with safety glass or fitted with a safety film as discussed All required records must be obtained for staff prior to their commencing working at the home. Records for existing staff must include all required information. Timescale for action By 30/10/05 2. OP19 13 By 30/11/05 By 4/10/05 3. OP29 19 4. OP29 19 By 30/11/05 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 OP25 Good Practice Recommendations The home should ensure that the lighting level in each service user room meets their needs. Choice D54-D07 S18337 Choice V241936 041005 Stage 4.doc Version 1.40 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
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