CARE HOMES FOR OLDER PEOPLE
Clayton House Victoria Terrace Saltburn-by-Sea TS12 1HN Lead Inspector
Val Daly Key Unannounced Inspection 17th October 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 Clayton House DS0000000106.V316007.R01.S.doc Version 5.2 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. Clayton House DS0000000106.V316007.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Clayton House Address Victoria Terrace Saltburn-by-Sea TS12 1HN 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) 01287 622468 Mrs Robina Hird Ms Karen McKernan Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Clayton House DS0000000106.V316007.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22nd February 2006 Brief Description of the Service: Clayton House is a converted Victorian building with an extension added. There is a well-maintained garden with lawns, fruit trees, flowerbeds and shrubs. The home is located in a quiet residential area of Saltburn. Local facilities and shops are approximately half a mile from the home but there is a local corner shop near to the home. Accommodation is provided for nineteen people in 17 single and 1 double room. The home has a comfortably furnished lounge, which overlooks the front garden. The dining room is light, airy and attractively furnished. The weekly fees for the home start from £355 to £375. Clayton House DS0000000106.V316007.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was a key inspection and was completed by one inspector over one day. As a key inspection, all of the key standards were examined. A tour of the home took place, residents records were examined, records including accidents, complaints and menus were looked at and three residents, two members of staff and the manager were engaged in discussion about life at Clayton House. What the service does well: What has improved since the last inspection?
There is a full self-audit programme in place, which covers all areas of the home. Each month a number of different areas are audited; finance records, complaints, housekeeping, medication, accidents, catering. Following this an action plan is put in place for improvements if required. Resident’s views are sought in regular meetings and periodically questionnaires are completed regarding, activities, food and general views of the home. The manager has undertaken and completed the Registered managers Award. More than 70 of the carers have undertaken and completed NVQ level 2 or above, which is over the required number of 50 . Clayton House DS0000000106.V316007.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Clayton House DS0000000106.V316007.R01.S.doc Version 5.2 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 Clayton House DS0000000106.V316007.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs are assessed. Care plans are developed and in place from these assessments that identify individuals needs. EVIDENCE: The inspector viewed two care records and they included the care manager’s assessment prior to entry to the home. The home manager then visits the potential service user to ensure that the needs can be met at Clayton House. The assessment is based on activities of living and physical well-being. The care records were comprehensive and informative and well written. The home does not provide intermediate care. Clayton House DS0000000106.V316007.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning, risk assessments and reviewing are robust. Residents’ health care needs are met, medication systems are appropriate and residents are treated with dignity and respect. EVIDENCE: The three care files examined each contained an individual plan of care. They were detailed and evaluated monthly. There was also evidence to show that the manager audits the plans regularly. The plans could be improved by having a ‘pen picture’ of the resident in place. Whilst information about the resident is included in the documentation in different places, it needs to be gathered together to form a ‘picture’. Annual reviews from Social services are held with residents and relatives being invited to attend. The documentation showed that the resident’s health care needs were being met. Risk assessments are in place where needed. The documentation showed that a risk assessment of all areas is carried out within a month of admission.
Clayton House DS0000000106.V316007.R01.S.doc Version 5.2 Page 10 Policies and procedures are in place for the ordering, receipt, storage, disposal and administration of medication. Examination of medication administration records showed that the procedures were being followed. The records included a space for a photograph of the resident. The manager said that she was in the process of having photographs taken and put in place. At the time of the inspection there were no residents who managed their own medication. The manager carries out a monthly audit of the medication. Three residents were spoken to during the inspection; they all said the staff respected their privacy. Clayton House DS0000000106.V316007.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s preferences and social needs are provided for and contact arrangements are in place and flexible. Residents are provided with a varied diet. EVIDENCE: Three residents were spoken to during the inspection. Two residents said that ‘enough goes on in the home to keep them occupied’. Music was being played in the lounge and the residents were enjoying singing along. There are trips out to the local shops, theatre, community centre and more organised outings in the summer months if residents wish to go out. Relatives and friends are invited to social evenings in the home and at the time of the inspection residents were discussing the forthcoming pie and peas supper. Religious services take place in the home and residents are able to receive communion every month if they wish. The menus showed that a variety of home cooked food is offered to the residents. There are choices for every meal and residents also said that if they didn’t like any of the food on the menu the staff would make something else for them.
Clayton House DS0000000106.V316007.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents know how to complain and the home has an appropriate procedure in place. Training for staff in adult protection has taken place, keeping residents safeguarded. EVIDENCE: The home has a detailed complaints procedure and supporting records. There was documentation in place, which showed that staff had undertaken and completed training in ‘Adult Protection’ in a workshop session. Two staff interviewed both confirmed they had received the training and were aware of the procedure to follow in the case of suspected abuse. Clayton House DS0000000106.V316007.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clayton House is homely, comfortable and well maintained. EVIDENCE: A tour of the home was carried out. Resident’s bedrooms contained personal possessions and were comfortable and homely. Maintenance certificates were in place and up to date. The home was clean and odour free. Since the previous inspection new dining chairs had been purchased for the dining room. The conservatory was in the process of being re furbished, with some building work being carried out. Two bathrooms on the first floor had been repainted and one refurbished with a new toilet and wash hand basin. Clayton House DS0000000106.V316007.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 &30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The vetting and recruitment practices are robust. Staffs is trained and qualified and relevant information that safeguards residents’ is in place. EVIDENCE: The home has a rota in place, which is flexible for the needs of the residents. There is a policy and procedure in place for the recruitment of staff. Staff records showed that the required information, references and CRB checks were in place prior to staff commencing work in the home. Staffs receive induction training, which runs alongside ‘Skills for Care’ induction programme. The home has a training plan in place and since the previous inspection staff had undertaken training in many areas such as NVQ 2 and 3, Adult Protection, Fire Safety, Moving and Handling, First Aid, Care Planning, Control of Infection, Food Hygiene. More than 70 of the carers have undertaken and completed NVQ level 2 or above, which is over the required number of 50 . Clayton House DS0000000106.V316007.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home regularly reviews aspects of its performance through a good programme of self-review, which include seeking the views of residents, staff and relatives. Finance systems are robust. Staff are appropriately supervised. Clayton House DS0000000106.V316007.R01.S.doc Version 5.2 Page 16 EVIDENCE: The manager has undertaken and completed the Registered Managers Award. The management team of the home have a weekly meeting and all areas of the home are discussed. There is a full audit programme in place, which covers all areas of the home. Each month a number of different areas are audited; finance records, complaints, housekeeping, medication, accidents, catering. Following this an action plan is put in place for improvements if required. Resident’s views are sought in meetings and periodically questionnaires are completed regarding, activities, food and general views of the home. Staff views are also requested in regular meetings and annual questionnaires however, not all staff completes them. Resident’s finances and records were kept appropriately with signatures in place. Documentation showed that water temperatures are taken weekly and was within the recommended range. The manager completes a summary of accidents they are analysed monthly. A formal staff supervision programme is in place and staff interviewed confirmed they receive supervision. Annual appraisals also take place and this has recently been changed to a 3600 appraisal. Staffs receive regular training in Health and Safety and there is a full training plan in place. It was noted on looking around the home that a few of the bedroom doors were wedged open, and discussion took place with the manager. Alternative arrangements must be made for fire safety. Clayton House DS0000000106.V316007.R01.S.doc Version 5.2 Page 17 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 3 X 3 Clayton House DS0000000106.V316007.R01.S.doc Version 5.2 Page 18 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 OP38 Regulation 13 © Requirement Alternative arrangements must be made to hold bedroom doors open. Timescale for action 30/12/06 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 OP7 OP9 Good Practice Recommendations The care plans could be improved by adding a ‘pen picture’ of the resident. The medication records could be improved by the addition of a photograph of the resident. Clayton House DS0000000106.V316007.R01.S.doc Version 5.2 Page 19 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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