CARE HOMES FOR OLDER PEOPLE
Cloisters 5 Abbotsford Road Blundellsands Liverpool Merseyside L23 6UX Lead Inspector
Mrs Trish Thomas Unannounced Inspection 10th January 2006 11:30 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 Cloisters DS0000005410.V277750.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. Cloisters DS0000005410.V277750.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Cloisters Address 5 Abbotsford Road Blundellsands Liverpool Merseyside L23 6UX 0151 924 3434 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Bernadette Neale Mr Stephen John Neale Mrs Hazel Welsh Care Home 20 Category(ies) of Dementia (20) registration, with number of places Cloisters DS0000005410.V277750.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 20 DE. Date of last inspection 18/07/05 Brief Description of the Service: Cloisters is a permanent care home, registered in the category of dementia for twenty elderly people. The home is owned by Mr. S. and Mrs. B. Neale, and the registered manager is Mrs. Hazel Welsh. The building is a detached Victorian house with a car park at the front and an enclosed and wellmaintained garden at the rear. Cloisters is close to a train station and bus routes and is situated in a quiet residential area. The home has a passenger lift to all levels and there are sixteen single and two double rooms, all with call bells. Bedrooms are located on the ground and upper floors. There are two large lounges and a dining room, which seats twenty people and is also used for activities sessions. The home is staffed throughout the day and night and care staff are trained to NVQ level in direct care. Cloisters DS0000005410.V277750.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The home was visited during late morning and the methods used during the inspection were, discussion with residents, the manager and staff. The lounges, dining room and utility areas were visited. Records relating to care practice, health & safety and staffing were read. As residents are assessed with dementia and could not fully express their opinions, much information relating to residents’ experiences of Cloisters, was obtained through direct observation and by reading their care files. Requirements from the last inspection were checked and had been met. What the service does well:
Cloisters provides a specialist residential care service to older people who have dementia. The home provides a comfortable and well-maintained environment and, during the inspection attention had been paid to residents’ comfort and wellbeing. The manager and staff have many years experience in dementia care, and training and updates for staff are ongoing. The home has a well-organised system for maintaining the records relating to care practice, staffing and health and safety. The home has a comprehensive procedures manual, which is available to staff. Care Plans were in place for all residents and, in practice, (other than where a requirement is made), the process appeared to be addressing identified needs. Staff were observed speaking with residents respectfully, and residents who were in the lounges were supervised at all times. Cloisters DS0000005410.V277750.R01.S.doc Version 5.1 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. Cloisters DS0000005410.V277750.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 Cloisters DS0000005410.V277750.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): 3 The home was meeting standard 3 regarding assessment of needs prior to admission. All residents admitted to the home have a documented mental health assessment and a general assessment of personal care/health needs prior to admission. EVIDENCE: A discussion took place with the manager, Mrs. Walsh, and three care files were read. There is a standard assessment form, which is completed for residents prior to admission by home’s staff, to ascertain that the prospective resident’s physical, mental health and medical support needs may be met by the skills and facilities available in the home. Mrs. Walsh confirmed that psychiatric/social work assessments are faxed from the relevant agencies for residents referred to Cloisters. A basic care plan is formulated during the first month of the resident’s stay, (which is a trial period). After the first month, a more in depth care plan is established for the resident, which is reviewed each month and updated. Risk assessments are carried out for individual residents, which are regularly monitored and updated.
Cloisters DS0000005410.V277750.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 The home has a care planning process in place, and care plans were in place for all residents. Some care plans had not been updated regarding the behaviour patterns of individual residents, which had been recorded on the daily report sheets. All residents are registered with a G.P. and have access to health and paramedical services. The home has a procedure for the management of residents’ prescribed medication. EVIDENCE: A sample of three care plans was read. These had been compiled in accordance with mental health assessments and a general assessment of need carried out by home’s staff. All residents have a key worker and their care plans are reviewed each month and are updated with regards to any identified change in need. In some instances, behaviour patterns recorded on daily report sheets, such as challenging behaviour towards staff, lethargy and unsettled sleep patterns, had not been updated and addressed in the relevant care plans.
Cloisters DS0000005410.V277750.R01.S.doc Version 5.1 Page 10 The files of a sample of care plans referred to contained professional visit sheets where contact with health professionals is recorded. All residents are registered with a G.P. and a requirement from the last inspection regarding access to paramedical services had been addressed. The home has a written medication procedure, which was discussed with the manager. Mrs. Walsh said that none of the residents were self-medicating, due to their dementia and short-term memory loss. Staff who administer medication receive instruction (through shadowing/observation) and training. There is an established audit trail through the checking and recording of quantities, and pharmacy staff sign for monthly returns of unwanted drugs. Medication is stored in a locked trolley, which is padlocked to the wall and the person in charge of administering prescribed medication is the nominated keyholder. Best practice was noted in that a file is maintained of pharmacy information on side effects of drugs, which staff refer to, for awareness of any possible change in the condition of a resident which may occur after taking their medication. Cloisters DS0000005410.V277750.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, 15 A number of in-house activities are provided for the residents and the home has made arrangement for religious ministers to visit regularly. The home provides home-cooked meals, which are served in a pleasant dining room. EVIDENCE: The home has an activities diary and information on the day’s events is posted on the residents’ notice board. The manager said that some of the residents had been out for a meal before Christmas and seasonal events, had been enjoyed, including carol services by local choirs. The manager said that the majority of residents do not go on outings and that their families are encouraged to visit. Religious ministers from local churches visit Cloisters regularly, in accordance with the needs and preferences of those in residence at any time. Personal profiles for individual residents are contained in their care plans and the manager said their cultural needs are met in accordance with information provided by residents and their representatives. Five residents were asked about lifestyle in the home and they appeared content but, due to short term memory loss, could not given details of any recent social events. Time was spent with residents in the lounges and hey appeared relaxed and at ease with the staff who were on duty.
Cloisters DS0000005410.V277750.R01.S.doc Version 5.1 Page 12 The dining room and kitchen were visited. There were stocks of fresh, frozen and chilled foods in store and foods stocks in general, were in good supply. There is a four-week rotating menu, which is seasonally adjusted and there is an alternative menu available. Residents are weighed monthly, their weight charts are monitored and consistent loss of weight would be referred to the G.P. Residents’ weight charts were observed in care files and no weight loss was noted in the sample, which was read. Four residents who were spoken with said they had enjoyed their meal. One lady said “we don’t go short of anything here.” The dining room is adjacent to the kitchen and is bright and well presented. Cloisters DS0000005410.V277750.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The home has procedures in place for investigating complaints, for protection of vulnerable adults, and “whistle blowing.” Staff who work in the home have received relevant training in support of the procedures in place. EVIDENCE: The home has a complaints procedure and a record of complaints is maintained for inspection. There have been no complaints investigated by CSCI regarding Cloisters, since the last inspection. The home has an adult protection procedure and whistle blowing policy. The manager confirmed that, in recent months, staff have received training in protection of vulnerable adults (training courses have been provided to staff, both in-house and from an external training organisation). Cloisters DS0000005410.V277750.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): 19,26 The home is well maintained and comfortable and appears to meet the needs of those in residence. The home was clean and hygienic and has systems in place for the control of infection. EVIDENCE: Cloisters is maintained to a very good standard and has a homely atmosphere. The home is well integrated with domestic dwellings in the street and the exterior is well maintained and welcoming. Furnishing and fittings are domestic in style and in keeping with the age of the building and the needs of residents. The building is in good decorative order and the rear garden is secluded, well maintained, accessible and secure for residents’ enjoyment, with seating and shade provided. The home has an ongoing maintenance programme and employs a handyperson. Cloisters DS0000005410.V277750.R01.S.doc Version 5.1 Page 15 The home was clean and well organised in the areas visited, lounges, dining room, kitchen and laundry. There are procedures in place for the control of infection and containment and use of cleaning materials. A member of staff said that protective gloves and aprons are available to them and they have, in recent months, attended training in infection control. The home has a clinical waste disposal policy and employs domestic staff, who are included on the roster. Cloisters DS0000005410.V277750.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 The home has a robust recruitment procedure, which is followed in appointing new members of staff. On appointment, staff are provided with contracts of employment and job descriptions. EVIDENCE: Reference was made to a sample of staff files. These were seen to contain proof of identity, job application forms, Criminal Records Bureau clearances, employers’ references, Contracts of Employment, Job Descriptions and records of induction training. The manager confirmed that staff receive regular formal supervision (one to one), and that all staff have an individual training plan to ensure that NVQ and mandatory training is regularly updated. Cloisters DS0000005410.V277750.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 38 The home has systems in place to monitor the views of residents and their representatives. Written records are maintained of transactions relating to residents’ personal allowances. A recommendation is made with regards to dual signatures to these records. Health and safety certification was satisfactorily maintained and requirements from the last inspection had been addressed. A requirement is made regarding storage of food in the freezer. Cloisters DS0000005410.V277750.R01.S.doc Version 5.1 Page 18 EVIDENCE: Reference was made to Quality Assurance questionnaires and discussion took place with the manager. A quality audit of Cloisters is carried out annually by an independent assessor. The most recent questionnaires were from September 05. The manager said she would take remedial action, to address any quality issues, which may be identified in questionnaires. The outcomes of quality audits are made available to residents and their representatives. Mrs. Walsh confirmed that the home does not become involved in residents’ financial affairs. As residents of Cloisters do not have capacity to manage their own monies, families/solicitors have this responsibility and where appropriate, residents would have access to independent advocates. In some instances, residents’ personal allowances are held in the home to cover their day-to-day expenses such as hairdressing and personal items. Mrs. Walsh said that a record of all transactions is maintained and receipts for purchases are retained. The records were seen and a recommendation is made that rather that one staff signature to transactions, the figures are checked and double signed by two members of staff. Reference was made to health and safety certification and the home’s procedures. There are systems in the home to manage infection control and domestic staff are provided with protective clothing. Cleaning materials are managed under COSHH regulations. Environmental risk assessments are carried out and equipment is regularly maintained. The fire book was in order and checks and training were up to date. A requirement is made regarding storage of food in the freezer, which must be contained, sealed, and labelled with the content and date. A requirement is made regarding the testing and recording of water temperatures in baths and showers, which must be carried out weekly and maintained at 43 degrees. Cloisters DS0000005410.V277750.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 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 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 2 X X 2 Cloisters DS0000005410.V277750.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation 15 (2)(b) Requirement Timescale for action 11/01/06 2. OP38 13 (4) (c) 3. OP38 13 (3) The manager must ensure that residents’ care plans are reviewed and updated in relation to changes in their behaviour. Timescale, ongoing from the date stated. The manager must arrange for 24/01/06 water in baths and showers to be tested weekly and maintained at 43 degrees. Timescale, ongoing from the date stated. The manager must ensure that 11/01/06 food stored in the freezer is contained, sealed and labelled. Timescale, ongoing from the date stated. Cloisters DS0000005410.V277750.R01.S.doc Version 5.1 Page 21 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 OP35 Good Practice Recommendations The manager should obtain two signatures to all transactions relating to residents’ personal allowance. Cloisters DS0000005410.V277750.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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