CARE HOMES FOR OLDER PEOPLE
Church View (Residential Home) Limited Church Street Oswaldtwistle Lancashire BB5 3QA Lead Inspector
Mrs Susan Hargreaves Unannounced Inspection 10:30 6 September 2006
th 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 Church View (Residential Home) Limited DS0000066410.V289131.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. Church View (Residential Home) Limited DS0000066410.V289131.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Church View (Residential Home) Limited Address Church Street Oswaldtwistle Lancashire BB5 3QA 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) 01254 381652 01254 239863 Church View (Residential Home) Limited Mrs Kathleen Haslope Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Church View (Residential Home) Limited DS0000066410.V289131.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home is registered for a maximum of 32 service users, to include: Up to 32 service users in the category of OP requiring personal care. The care home should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief Description of the Service: Church View Care Home Oswaldtwistle was purpose built in 1988. It is a single storey building, with level access, situated in its own well-kept grounds. The home is in the centre of the town of Oswaldtwistle, close to all local amenities. Church View Care Home is registered to provide 24-hour personal care for up to 32 older people aged 65years and over. Accommodation is offered in single en-suite bedrooms. Communal rooms include 3 lounges and 2 dining rooms. The garden is easily accessible to all residents. The current fees charged at Church View are £320 to £360.50 per week. Additional charges are payable for hairdressing. An information leaflet about the home was available to prospective residents and their relatives on request. Church View (Residential Home) Limited DS0000066410.V289131.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over eight hours. No additional visits have been made since the last inspection. At the time of this inspection 30 residents were living at the home. A tour of the premises took place and staff files and care records were inspected. Members of staff on duty, residents and a visitor were spoken to. Discussions also took place with the manager regarding issues raised during the inspection. What the service does well: What has improved since the last inspection?
Since the last inspection care plans are in place from the day of admission. The procedure for recording the administration of controlled drugs has improved and appropriate records are kept. Recruitment procedures are thorough. Two written references and CRB/POVA checks had been obtained for the members of staff appointed since the last inspection. Church View (Residential Home) Limited DS0000066410.V289131.R01.S.doc Version 5.1 Page 6 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. Church View (Residential Home) Limited DS0000066410.V289131.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 Church View (Residential Home) Limited DS0000066410.V289131.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 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A statement of purpose and service user guide was not available. Admission procedures were thorough. EVIDENCE: A leaflet giving information about the home was available for prospective residents and their relatives. The manager explained that she was working with senior staff within the company in order to write a new statement of purpose and service user guide. The individual records of four residents were inspected. These contained a pre-admission assessment. This assessment provided important information for the care plan. Prospective residents received confirmation in writing that their needs could be met at the home. Standard 6 is not applicable to this service. Church View (Residential Home) Limited DS0000066410.V289131.R01.S.doc Version 5.1 Page 9 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Privacy and dignity was promoted for all residents. Care plans did not contain detailed information relating to all aspects of care. Some procedures relating to medication put residents at risk. EVIDENCE: The individual care plans of four residents were inspected. Although these records plans identified the care needs of each resident they did not provide clear guidance for staff to follow to ensure these needs were met. Appropriate risk assessments were in place. However, where a risk e.g. of developing pressure sores or falls had been identified a care plan about the action being taken to address the risk was not in place. Care plans and risk assessments were reviewed monthly and it was evident that residents of their relatives were involved in care planning. A written report about the care given to individual residents was completed during each shift. Residents were registered with a GP and had access to other healthcare professionals. Policies and procedures for the management of medication were in place. A risk assessment had been carried out for a resident who wanted to selfChurch View (Residential Home) Limited DS0000066410.V289131.R01.S.doc Version 5.1 Page 10 medicate. Members of staff responsible for the administration of medication had received appropriate training. However, medication was being given to a resident from an incomplete monitored dose container, which was unnamed and not labelled with the names of the tablets. Accurate records of medication received into the home were not kept. A quantity of medication to be returned to the chemist was stored at the home some dated 21/01/06. The last record of any medication returned to the chemist was dated 10/04/06. An excessive amount of medication was kept at the home for several residents. This included four and half months supply of medicine for one resident and a large quantity of paracetamol for another resident. A senior member of staff explained the paracetamol had been prescribed for a resident who no longer needed to take them regularly. She was advised to ask the doctor to review medication when the needs of the resident changed. Hand written instructions on the medicines administration records were not signed or witnessed. Written instructions were not in place advising when medication prescribed ‘when required’ should be given to individual residents. Poor practice was observed at teatime on the day of the inspection when medication was left on the dining table for a resident. This practice increases the risk of error and must cease. Medication was stored correctly inside a locked cupboards and trolleys inside a locked utility room. The temperature of this room was checked and recorded daily. Controlled drugs were stored correctly and a stock check was satisfactory. Personal care was carried out in private. Members of staff were observed attending to residents in a polite and friendly manner. Two members of staff explained in detail how they promoted privacy and dignity for all residents. One resident said, “ The staff are perfect.” Church View (Residential Home) Limited DS0000066410.V289131.R01.S.doc Version 5.1 Page 11 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A variety of leisure activities were organised for residents. Visitors were welcomed into the home at anytime. The daily routine was flexible in order to meet the needs and preferences of residents. Meals were wholesome and appetising. EVIDENCE: Residents were encouraged to pursue their own interests or hobbies or choose from a range of games and activities organised by members of staff. These included, bingo, skittles, dominoes, manicures and videos. Exercises to music were organised every fortnight by a visiting professional. Residents said that their relatives and friends were welcome to visit at anytime and offered refreshments. Local clergy regularly visited the home. Residents and staff confirmed that the daily routine was flexible. Information about each resident’s lifestyle and preferred daily routine was included in their individual care plan. Residents got up and went to bed at a time of their choosing. One resident said, “you can get up and go to bed when you want.” Residents were encouraged to personalise their rooms with photographs, ornaments etc. All the residents asked said the meals were good. One resident said, “You get what you want.” The menus were varied and offered choice. The cook also
Church View (Residential Home) Limited DS0000066410.V289131.R01.S.doc Version 5.1 Page 12 explained that he would get tripe or black pudding etc if any resident wanted these items. Fresh fruit was offered to residents between meals. A bowl of fruit was also left in the dining room for residents to help themselves. Church View (Residential Home) Limited DS0000066410.V289131.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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints would be taken seriously and investigated. Appropriate procedures were in place to ensure the protection of residents at the home. EVIDENCE: A copy of the complaints procedure was displayed and included in the resident’s welcome pack. There have been no complaints to the home or the Commission since the last inspection. Policies and procedures relating to the protection of vulnerable adults were in place. This issue was discussed with two members of staff. They were aware of the procedure and said they would report any concerns immediately. Church View (Residential Home) Limited DS0000066410.V289131.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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean and comfortable and provided a homely environment for the residents. Laundry facilities were appropriate for the size of the home. EVIDENCE: At the time of the inspection the home was clean, tidy, free from offensive odour and well maintained. This provided a safe and comfortable environment for the residents. The manager explained that bedrooms were redecorated and the carpet in en-suite facilities replaced with non-slip floor covering when they became vacant. Laundry facilities were appropriate for the size of the home. An infection control policy was in place. Church View (Residential Home) Limited DS0000066410.V289131.R01.S.doc Version 5.1 Page 15 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels were appropriate to meet the assessed needs of the residents. Recruitment procedures were thorough. Sixty six percent of care staff had an NVQ qualification in care. Induction training needed further development to ensure consistency in the delivery of care. EVIDENCE: Examination of the duty rota confirmed that a sufficient number of staff were on duty for all shifts to meet the assessed needs of the residents. The files of three members of staff appointed since the last inspection were examined. These files indicated that all the required pre-employment checks to ensure protection of the residents had been completed prior to appointment. It was evident from discussion with members of staff that training was encouraged. This included first aid, moving and handling, basic food hygiene, fire safety, management of medication, optical awareness, incontinence and dementia. Eleven members of staff had an NVQ level 2 in care and one had NVQ level 3. A further two members of staff were working towards NVQ level 3 and one to level 2. Induction training for new employees took place but this did not meet the ‘Skills for Care’ standard. Church View (Residential Home) Limited DS0000066410.V289131.R01.S.doc Version 5.1 Page 16 Church View (Residential Home) Limited DS0000066410.V289131.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): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Members of staff felt supported by the manager. Residents and their relatives were consulted about the quality of the care and services provided at the home. Procedures to safeguard the health, safety and welfare of residents require further development. EVIDENCE: The registered manager has many years experience of caring for older people. She maintains an up to date knowledge of current practice by attending relevant training courses and reading a variety of care publications. Members of staff said the manager was supportive, understanding and always listened to their concerns. The home had achieved the nationally accredited Investors in People award. Residents and their relatives were encouraged to express their opinions about
Church View (Residential Home) Limited DS0000066410.V289131.R01.S.doc Version 5.1 Page 18 the quality of care at anytime. Anonymous satisfaction questionnaires were distributed to residents. Records of transactions involving resident’s money were seen to up to date. Policies and procedures relating to safe working practices were available. The manager explained that fire alarms and emergency lighting were tested weekly. However, records to support this were not available from May 2006. The last recorded fire drill took place on 8 March 2006. A fire risk assessment was seen and members of staff had received training in fire safety. Records of the routine servicing of equipment were seen. Testing of small electrical appliances had taken place in April 2006. To improve safety within the home arrangements were being made for a new fire alarm panel to be fitted and for necessary electrical work to be done in order to meet the standard required to renew the electrical installation certificate. A gas safety certificate was not available. A member of staff qualified to administer first aid was on duty for all shifts. It was evident from the information received from the the manager before the inspection that reports of incidents which adversely affect the health and welfare of residents had not been sent to the commission. This includes serious illness or injury and deaths. Records maintained by the cook included fridge, freezer and food temperatures. Safety notices were displayed in the home. Church View (Residential Home) Limited DS0000066410.V289131.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 1 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Church View (Residential Home) Limited DS0000066410.V289131.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4(1)(a)(b) (c) Schedule 1 Requirement Timescale for action 27/10/06 2. OP1 5(1) 3. OP7 15(1) The registered person shall compile in relation to the care home a written statement which shall consist of (a) a statement of the aims and objectives of the care home; (b) a statement as to the facilities and services which are to be provided by the registered person for service users; and (c) a statement as to the matters listed in Schedule 1. The registered person shall 27/10/06 produce a written guide to the care home which shall include; all items listed in standard 1 and regulation 5. Unless it is impracticable to carry 27/10/06 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. Care plans must provide detailed information about how all needs are to be met. Church View (Residential Home) Limited DS0000066410.V289131.R01.S.doc Version 5.1 Page 21 4. OP8 12(1)(a) (b) 5. OP9 13(2) 6. OP9 17(1)(a) Schedule 3(i) The registered person shall 27/10/06 ensure that the care home is conducted so as (a) to promote and make proper provision for the health and welfare of service users; (b) to make proper provision for the care and, where appropriate, treatment, education and supervision of service users. A care plan must be in place to address each identified risk Timescale of 30/12/06 not met. Care plans must provide detailed information about how all needs are to be met. The registered person shall make 22/09/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Medication must not be given to any resident from an improperly labelled container. Unwanted medication must be returned to the chemist after 7 days. Records of medication returned to the chemist must include the resident’s name. Excessive amounts of medication must not be stored at the home. Staff must ensure that all medication is given to the resident and not left on the dining table. The registered person shall 06/09/06 maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the service user. (i) a record of all medicines kept in the care home for the service user, and the date on which they were administered to the service user. Accurate records of all
DS0000066410.V289131.R01.S.doc Version 5.1 Page 22 Church View (Residential Home) Limited 7. OP9 14(2)(a) (b) 8. OP30 18(1)(c) (i) 9. OP38 13(4)(a) 10. OP38 23(4)(e) medication received into the home must be kept. The registered person shall ensure that the assessment of the service user’s needs is (a) kept under review; and (b) revised at any time when it is necessary to do so having regard to any change in circumstances. The GP must be asked to review medication when the needs of the resident change. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users – (c) ensure that the persons employed by the registered person to work at the care home receive (i) training appropriate to the work they are to perform. Induction training for new employees must meet ‘Skills for Care’ specification. The registered person shall ensure that (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. A gas safety certificate must be obtained. Timescale of 29/07/05 and 30/12/05 not met. The registered person shall after consultation with the fire authority – (e) to ensure, by means of fire drills and practices at suitable intervals, that the persons working at the care home, and so far as practicable, service users, are aware of the procedure to be followed in case of fire, including the procedure for saving life. Fire drills must take place regularly.
DS0000066410.V289131.R01.S.doc 22/09/06 27/10/06 27/10/06 27/10/06 Church View (Residential Home) Limited Version 5.1 Page 23 11. OP38 17(2) Schedule 4 (14) 12 OP38 37(1) The registered person shall maintain in the care home the records specified in Schedule 4. A record of every fire practice, drill or test of fire equipment (including fire alarm equipment) conducted in the care home and of any action taken to remedy defects in the fire equipment. The registered person shall give notice to the commission without delay of any occureence listed in (a) to (g) of regulation 37. 06/09/06 06/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP9 Good Practice Recommendations Hand written instructions on the medicines administration records should be signed and witnessed. Written instructions should be in place for individual residents stating when medication prescribed when required should be given. Church View (Residential Home) Limited DS0000066410.V289131.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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