CARE HOMES FOR OLDER PEOPLE
Close House Hexham Northumberland NE46 1ST Lead Inspector
Janet Thompson Unannounced 7 June 2005 09:30 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. Close House B53-B03 S536 CloseHouse V222896 190505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Close House Address Hexham Northumberland NE46 1ST 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) 01434 602866 N/A nursing@hexhamshire.com Mr D W Robson Mr J R Robson Ms Sylvia Margaret Robinson CRH 22 Category(ies) of OP - Old Age (22) registration, with number of places Close House B53-B03 S536 CloseHouse V222896 190505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 25.11.04 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 B53-B03 S536 CloseHouse V222896 190505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place in the afternoon. The Proprietor and Manager were present. The main purpose of the inspection was to check what progress had been made to address the requirements and recommendations of the last inspection. A tour of the building took place as well as inspection of some records relating to care and social activities. What the service does well: What has improved since the last inspection?
All requirements and good practice recommendations set at the last inspection have been addressed. Communication between the Proprietor, staff, residents and relatives has improved greatly. Residents and relatives are kept up to date through regular meetings and are consulted about their views. Staff meetings have been held and staff commented that they feel that they are listened to. Improvements to the premises have taken place since the last inspection.
Close House B53-B03 S536 CloseHouse V222896 190505 Stage 4.doc Version 1.30 Page 6 Toilet areas have been fully refurbished, a sluice disinfector has been purchased and all areas have been tidied. A lot of work has taken place to produce a care plan for each resident that addresses all needs and meets the requirements set in the national minimum standards. All these care plans have been discussed with the resident or their relatives who have signed their agreement. The standard of these care plans was very good. Reorganisation of staff files has taken place. It is now possible to check on staff training and progress. Staff recruitment procedures have improved and all documents in these files were well organised. The daily routines for staff have been reorganised to make sure that all staff receive information on residents at the beginning of their shift. This has improved communication generally within the home. One of the major improvements to take place is the introduction of a range of social activities and outings for residents. A wide variety of social events has taken place and it was reported that more and more residents are participating in this. The Inspector felt that residents appeared to be more alert and the atmosphere was lively. The Proprietor, Manager and staff have put a huge amount of work into improving the quality of life for residents and they are commended on this. What they could do better:
There have been so many recent improvements that it was not immediately apparent where any area could be done better. The challenge will now be to maintain the level set and continue to look for ways to improve. The building has restrictions due to its age. These are being acknowledged by the Proprietor, who is seeking ways to improve the size and structure of some rooms. Please contact the provider for advice of actions taken in response to this
Close House B53-B03 S536 CloseHouse V222896 190505 Stage 4.doc Version 1.30 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Close House B53-B03 S536 CloseHouse V222896 190505 Stage 4.doc Version 1.30 Page 8 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 Close House B53-B03 S536 CloseHouse V222896 190505 Stage 4.doc Version 1.30 Page 9 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) These standards were not assessed at this inspection. EVIDENCE: Close House B53-B03 S536 CloseHouse V222896 190505 Stage 4.doc Version 1.30 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) 7,8 and 10. Residents health care needs did appear to be well assessed and suitable care provided. Care plans were good. Staff did appear to treat residents with respect and adequate attention to privacy was given. EVIDENCE: Four care plans were examined. All information within them was well organised, they were well written and easy to follow. The inspector examined the care plan for one resident after meeting with her. The care plan did reflect the needs of this particular resident whose individual wishes were taken account of. From the information provided in the care plan it appeared that all health needs were assessed, planned, implemented and evaluated to a good standard. All assessments were well compiled. Residents looked clean, tidy and well cared for. Records showed that residents had been to visit dentists and had chiropody attention. Some bedrooms and toilets in the home have glass-panelled doors. These have recently been fitted with thicker lace panels to ensure that privacy is
Close House B53-B03 S536 CloseHouse V222896 190505 Stage 4.doc Version 1.30 Page 11 maintained. This was discussed at a recent relatives/residents meeting and residents were happy with this arrangement. During the tour of the building the Proprietor and Manager knocked on residents bedroom doors and asked permission to enter before showing the inspector in. This is good practice. Staff were also observed to knock on doors before entering residents rooms. Close House B53-B03 S536 CloseHouse V222896 190505 Stage 4.doc Version 1.30 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 and 15. Residents were provided with enough opportunities for social stimulation on a day-to-day basis. There was an adequate balance between choice and control. Family and friends were suitably included in resident’s lives. The food provided is adequate and suitable. EVIDENCE: All residents are asked about their social preferences and lifestyle in order to form the basis of a social programme. Two staff members are responsible for the provision and organisation of the social life at Close House. The Inspector spoke to one of these staff who stated that all staff are now involved in carrying out activities. A lot of work has gone into improving this area of life for residents with very good results. The staff stated that residents are becoming much more interested in what is going on and are beginning to make suggestions themselves. An attendance log is kept for activities, which states how much residents enjoyed, or otherwise, a particular event. Social activities varied from a small group getting together for coffee and Bailey’s to larger group outings, music evenings and exercise. Staff should be commended for their efforts in this area. Recently relatives have been offered the opportunity to meet with the Proprietor and influence changes in the home. This has taken the form of a
Close House B53-B03 S536 CloseHouse V222896 190505 Stage 4.doc Version 1.30 Page 13 meeting, which was well attended. The minutes from that meeting were available. Relatives and friends are able to visit the home at any time. They were observed to come and go in Close House in a relaxed way. The inspector spoke to one resident who described how she wished to undertake an activity that was of high risk to her personal safety. She stated that a compromise had been reached in that staff escorted her on this; she acknowledged that staff were concerned for her safety and felt happy with the solution. A risk assessment was in place for this situation; this had been discussed, documented and signed by all parties. This indicates a good balance between resident’s choice and control over their own lives coupled with the care homes duty of care. All residents spoken to commented that the food in the home was good. The Manager stated that a new chef had been employed and that the kitchen was running well. The breakfast menu has been extended to include a cooked breakfast. Close House B53-B03 S536 CloseHouse V222896 190505 Stage 4.doc Version 1.30 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) These standards were not assessed at this inspection. EVIDENCE: Close House B53-B03 S536 CloseHouse V222896 190505 Stage 4.doc Version 1.30 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) 19-26 The premises were suitable for their purpose and appeared safe and well maintained. All areas were clean, tidy and odour free. EVIDENCE: The home is generally well maintained and there are plans for further improvements. Grounds are well kept and service users have access to these. The home is a no smoking area. Furnishings were satisfactory and all areas appeared comfortable and homely. There are four lounge areas and one dining area, which provide plenty of space for service users. Toilets and bathrooms were tiled and there are 3 assisted bathrooms. These have been recently refurbished with very good results.
Close House B53-B03 S536 CloseHouse V222896 190505 Stage 4.doc Version 1.30 Page 16 Toilets are accessible and clearly marked. The home has a passenger lift and ramps as necessary to ensure service users are able to access all parts of the home. All grab and handrails were checked and were secure. There is a range of bedroom sizes, several being well over 10 square metres, however a small number are under 10 square metres. The provider is considering extending the home, and the use of two undersize rooms may be reconsidered then. En-suite facilities are provided in several rooms. There were not any hazardous substances unattended; there were not any obvious trip hazards. Windows have been fitted with restrictors. Fire exits were clear of obstructions and were clearly marked. In the interest of infection control a sluice disinfector machine has been purchased. All bins were fitted with lids and liners. Staff have received training on the importance of hand washing in addition to the use of a hand cleaning spray. The Proprietor has agreed to cover all light pull cords with plastic tubing that can be easily cleaned. Close House B53-B03 S536 CloseHouse V222896 190505 Stage 4.doc Version 1.30 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 and29. There were adequate amounts of staff scheduled to be on duty in the home. Staff recruitment was satisfactory. EVIDENCE: Close House is staffed to ratios of : 1 RGN at all times 4 care staff in the morning 3 care staff in the evening 1 care staff at night. The home was adequately staffed at the time of inspection. Staff files have been revised and now clearly show the checks that are undertaken to ensure that good recruitment practice is followed. One file was examined for the last person recruited. This contained all the necessary information. Records of registered nurse registration were checked and were correct as were records of Criminal Records checks. Close House B53-B03 S536 CloseHouse V222896 190505 Stage 4.doc Version 1.30 Page 18 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) 31, 32, 33, 34, 35, 36 and 37. The management of the home was carried out in a competent, open and inclusive manner. Management of files has improved resulting in better safeguarding of residents. Staff supervision was good. EVIDENCE: The manager is a Registered nurse with many years experience in care of the elderly person. There are clear lines of accountability in the home. The manager is not responsible for any other establishment. Close House B53-B03 S536 CloseHouse V222896 190505 Stage 4.doc Version 1.30 Page 19 The manager has instigated numerous improvements to the home since her appointment. The system for providing staff handover information has been reviewed to ensure that all staff receive all information at the beginning of their shift. The manager and Proprietor have now held meetings with staff and residents/relatives. This is planned to be a regular occurrence . A keyworker system has been introduced; the manager reported that this is working very well. The Proprietor has carried out a quality assurance survey; the results of this were examined. It appeared that all residents were happy with the care provided. Business and financial plans were not inspected. Insurance certificates were displayed. The home does not keep any money or valuables on behalf of service users. Service users have a lockable facility in their own rooms in which to keep such things. Supervision records examined were clear and detailed. All issues were fully followed up to the satisfaction of the supervisee. Supervision was planned to take place six times per year. The quality of the supervision content was good. Close House B53-B03 S536 CloseHouse V222896 190505 Stage 4.doc Version 1.30 Page 20 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 4 3 3 3 4 3 x Close House B53-B03 S536 CloseHouse V222896 190505 Stage 4.doc Version 1.30 Page 21 No 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 Regulation Requirement Timescale for action 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 Good Practice Recommendations Close House B53-B03 S536 CloseHouse V222896 190505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 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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