This inspection was carried out on 27th October 2005.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.
The inspector made no statutory requirements on the home as a result of this inspection
and there were no outstanding actions from the previous inspection report.
CARE HOMES FOR OLDER PEOPLE
Close House Hexham Northumberland NE46 1ST Lead Inspector
Janet Thompson Announced Inspection 27th October 2005 10:00 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 Close House DS0000000536.V249753.R01.S.doc Version 5.0 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. Close House DS0000000536.V249753.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Close House Address Hexham Northumberland NE46 1ST 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) 01434-602866 nursing@hexamshire.com Mr D W Robson Mr J R Robson Ms Sylvia Margaret Robinson Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Close House DS0000000536.V249753.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th June 2005 Brief Description of the Service: Close House is an adapted and extended building in a rural setting on the outskirts of Hexham. Close House is a family owned and managed business. The Proprietor has close involvement on a day to day basis. The two storey accomodation varies in room size and character. All parts of the building are accessible through a recently installed passenger lift. There are extensive attractive gardens surrounding the property and car parking at the main entrance. Close House can accomodate frail elderly people, some of who require nursing care. Close House DS0000000536.V249753.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection that took place through the week. The Manager and Proprietor were present throughout the inspection. Overall this was a good inspection resulting in only a few requirements. What the service does well: 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. Close House DS0000000536.V249753.R01.S.doc Version 5.0 Page 6 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 Close House DS0000000536.V249753.R01.S.doc Version 5.0 Page 7 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. Standard 6 is not applicable, intermediate care is not provided. All service users have had their needs assessed before moving into the home. EVIDENCE: The manager stated that all residents have their needs assessed prior to admission. This assessment takes account of information provided by current carers and other professionals such as care managers. Care plans examined confirmed that this is carried out. Assessments cover all areas of living and identify need. Residents spoken to confirmed that someone had been to see them before their admission. All residents spoken to said that their needs were met. Close House DS0000000536.V249753.R01.S.doc Version 5.0 Page 8 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 and 9 Service user plans did not clearly identify all areas of need. Service users are not totally protected by medication procedures. EVIDENCE: Two care plans were examined and case tracking carried out. Assessments were thorough and comprehensive. Some good information was recorded regarding resident’s needs and abilities. Some of the information was muddled between the actions required and the evaluations of the plan. This was discussed with the manager and she agreed to ensure that staff was clear regarding the process of care planning. Care assistants are not very involved in care planning, though they do have access to the care plans. The inspector advised that care assistants be actively encouraged to read the care plans and participate in the planning of care to ensure adequate communication. Care plans had not been reviewed monthly. The laws governing the disposal of medication have recently changed. The home is now required to dispose of all medication through a licensed operator. The management team have put in place good procedures for dealing with the extra responsibility that this brings. It was discussed that all medication disposed of by emptying it into the “cinbin” should be recorded in the same
Close House DS0000000536.V249753.R01.S.doc Version 5.0 Page 9 way as medications returns were recorded in the past; i.e. the name, description, strength and quantity of the drug, the residents name, date disposed of and signatures of two staff. Controlled medications stored in the safe, should be checked monthly as part of an audit. This should continue until they are rendered unusable by adding them to the chemical disposal kit. Their disposal should be recorded in the usual way. All medication administration records were checked. These showed that staff had not signed for drugs given on numerous occasions. The manager should address this through supervision and disciplinary procedures and set up an audit system to prevent this happening again. One amount of controlled drug was checked and was correct. Close House DS0000000536.V249753.R01.S.doc Version 5.0 Page 10 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 Service users lifestyle experience in the home matches their expectation. EVIDENCE: All residents spoken to say that they had enough to do. They were aware of the activities on offer and were able to choose whether to participate or not. Residents confirmed that they are encouraged to remain active and keep up any hobbies they had prior to admission. Social activities were covered in more depth at the last inspection. The inspector received twelve comment cards from residents and relatives prior to the inspection. All of these were very positive regarding the general care provided at Close House and eleven of these commented positively on the extent of activities. Close House DS0000000536.V249753.R01.S.doc Version 5.0 Page 11 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 Service users are confident that complaints will be acted upon. Service users were protected from abuse as far as possible by the policies and procedures in the home. EVIDENCE: The complaints procedure is available as part of the service users guide which is situated in the entrance hall. The complaints procedure is clear and easy to follow. Resident’s questionnaires showed that they did know who to complain to. Residents spoken to said that they would complain if they needed to. There have not been any complaints since the last inspection. More than half of the staff had received training in the protection of vulnerable adults. Some of this has been as part of NVQ training. Local guidance and policies relating to vulnerable adults was available in the home. Close House DS0000000536.V249753.R01.S.doc Version 5.0 Page 12 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): These standards were not assessed at this inspection. EVIDENCE: Close House DS0000000536.V249753.R01.S.doc Version 5.0 Page 13 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 and 30 The numbers of staff meets Service users needs. Staff are trained to do their jobs. EVIDENCE: There were sufficient numbers of staff on duty. The staffing ratio at Close House is: 1 Registered Nurse at all times 4 carers in the morning 3 carers in the evening 1 carer at night. A training plan and overview is in place. This showed that all staff were up to date with statutory training. Some additional vocational training ahs also been provided as a matter of good practice. Close House DS0000000536.V249753.R01.S.doc Version 5.0 Page 14 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): 36 and 38. Staff are formally supervised. Poor moving and handling practice compromise the health and safety of service users. EVIDENCE: Staff do receive formal supervision. This occurs in planned and scheduled sessions. The manager reported that staff have found the sessions beneficial. Supervision was inspected in more depth at the last inspection of the home. During discussions with residents it was apparent that staff are manually lifting some residents. The nurse who explained that the resident did not like the hoist confirmed this, in one case. All staff had received appropriate manual handling training, the inspector advised that staff practice should not differ from training. Manual lifting of residents is not acceptable practice. Close House DS0000000536.V249753.R01.S.doc Version 5.0 Page 15 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 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x 4 x 2 Close House DS0000000536.V249753.R01.S.doc Version 5.0 Page 16 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 Timescale for action Care plans should be reviewed to 01/12/05 ensure that actions and evaluations are recorded separately. All care plans should be reviewed monthly. Medication disposal should be 01/12/05 clearly recorded. All controlled drugs, kept prior to disposal should be checked monthly. Nurses must be reminded of their responsibilities regarding recording of medication. The manager must ensure that correct moving and handling techniques are followed. Requirement 2. OP9 13(2) 3. OP38 13(5) 01/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Close House DS0000000536.V249753.R01.S.doc Version 5.0 Page 17 No. 1. Refer to Standard OP7 Good Practice Recommendations It is strongly recommended that care assistants are actively encouraged to participate in care planning. Close House DS0000000536.V249753.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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