Inspection on 19/06/06 for Close (The)

This inspection was carried out on 19th June 2006.

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.

Other inspections for this house

Close (The) 19/10/09

Close (The) 21/09/07

Close (The) 21/02/06

Close (The) 05/09/05

Close (The) 21/02/05

Close (The) 09/09/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Close (The) 20 North Avenue Ashbourne Derbyshire DE6 1EZ Lead Inspector Angela Kennedy Key Unannounced Inspection 19th June 2006 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 (The) DS0000019961.V297601.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. Close (The) DS0000019961.V297601.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Close (The) Address 20 North Avenue Ashbourne Derbyshire DE6 1EZ 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) (01335) 345228 01335 345228 bostockk4@aol.com Parwich Hospital Trust Mrs Donna Bradley Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Close (The) DS0000019961.V297601.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st February 2006 Brief Description of the Service: The Close is a large detached Grade 2 listed Victorian house, set into the side of the hill within a short distance of the town centre of Ashbourne. The internal structure of the home retains many Victorian features such as high ceilings and tiled Minton floors. The home has nine single bedrooms and three double bedrooms. All the bedrooms are light and spacious and have been personalised. There are no en-suite facilities. There are two lounges and a dining room, all of which are well decorated with good quality furnishings and fittings. There is an attractive garden area, which is accessible to residents. Support services are in place with a choice of General Practitioners, district nurses, chiropodist, dentist and optician. Community psychiatric nurses, occupational therapists, physiotherapists and dietician are accessed as required. Staff training takes place to inform and enable staff to care for service users appropriately. Regular entertainment is organised and those service users who wish to go out do so. The current scale of charges at the time of inspection was, £375 per week for a single room and £ 345 per week for a double/shared room. Information regarding the home can be obtained by contacting the manager. Close (The) DS0000019961.V297601.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was an unannounced key inspection, which took place over a four-hour period. During the inspection several of the homes records and documents were seen which included the personal care files of two residents and the personal recruitment and training files of two staff members. Other documents seen related to the health and safety and care practices of the home. Several residents and two members of staff were spoken with. A tour of the building was undertaken and the staffs’ interaction with the residents was noted during the inspection. The registered manager was available throughout the inspection to provide the relevant documents and information required. What the service does well: What has improved since the last inspection? Requirements and recommendations from the last inspection relating to medication practices have now been met which enhances residents safety and the safe working practices of the home. The homes Adult Protection procedure is in the process of being reviewed to ensure that it reflects Derbyshire’s local procedure to ensure a consistent Close (The) DS0000019961.V297601.R01.S.doc Version 5.2 Page 6 approach is delivered regarding any adult protection issues, which will further promote and protect the welfare of the residents at the home. 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 (The) DS0000019961.V297601.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 Close (The) DS0000019961.V297601.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 Residents receive a written contract on admission to the home. The home ensures that it can meet the needs of each resident by undertaking a needs assessment prior to admission. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Of the two residents files seen, contracts regarding the Terms and conditions of the home were in place within the residents files and had been signed and dated by the resident and/or their representatives. Two residents files were looked at, one of the residents had recently moved into the home. Both of the files seen demonstrated that a detailed assessment of need had been undertaken. A preliminary assessment form had been completed which gave details weight; height, build, mobility, physical well being and personal care needs, this demonstrates that the home gathers the relevant information to allow them to monitor any changes in residents’ general health following admission. Close (The) DS0000019961.V297601.R01.S.doc Version 5.2 Page 9 One of the residents files seen demonstrated that their care manager as required had reviewed the resident’s assessment of need. The other resident had recently moved into the home therefore no reviews had taken place. Close (The) DS0000019961.V297601.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9,10 Resident’s health, social and personal needs are set out in an individual plan of care. Further staff require training in the administration of medication to ensure residents welfare is maintained at all times. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Care plans were in place in the two residents files seen and had been developed from the individual residents needs assessment that had been undertaken prior to admission. The care plans assessed each area of daily living with an emphasis on each individual residents daily routine/s. All areas of care were assessed including, personal care, assistance with meals and apetite, special service needs such as occupational therapy, physiotherapy, dentist, chiropody, speech and language therapy and dietician. Others areas of needs were also assessed; social needs and relationships, activities, likes and dislikes, prescribed medication and general health. Care plans were reviewed/evaluated and any changes made were recorded in red within the care plans, although not all were signed and/or dated. Consideration should be given to the method used for reviewing care plans to Close (The) DS0000019961.V297601.R01.S.doc Version 5.2 Page 11 ensure that each review is communicated effectively in a format that was easy to understand/self explanatory, this was discussed with the registered manager. Within the care plans seen there was no written evidence to suggest that residents were consulted or involved within their care plans. Risk assessments were in place within the two files seen, these included assessments regarding nutrition, history of falls, risk of pressure sore development and moving and handling and dependency levels. In one of the files these risk assessments were dated November 2004 and no clear evidence was in place to demonstrate that they since been reviewed. Consideration should be given to the format used within residents’ personal files for documenting any day-to-day concerns/issues or events regarding each individual resident. As the present system has two sections, and evaluation of need’ section and a ‘daily communication’ section, and both appeared to either duplicate or contradict the information within the other section. Requirements from the previous inspection regarding medication have been met. However the manager confirmed that only one member of the night staff had been trained to administer medication. The registered manager said that no residents required regularly prescribed medication at night, and only the occasional prescribed antibiotic was administered, but if this was required when the member of staff who had undertaken medication training was off duty then this medication may have to be administered by untrained staff. This does not promote safe working practice and could potentially place residents at risk. Residents spoken with were very complimentary regarding the care and support provided by the staff team and confirmed that their privacy and dignity was maintained by the staff at all times. In the residents files seen there preferred names were documented, ensuring that all staff were aware of each residents preferred form of address. During a tour of the building the shared bedrooms were seen and screening was provided around the beds to ensure that privacy could be maintained when personal care was provided or at any other time. Private telephone lines or access to a telephone were available to all residents at the home. Close (The) DS0000019961.V297601.R01.S.doc Version 5.2 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 the following standard(s): 12,13,14,15 The home ensured that residents maintained contact with their family and friends and their social, religious and recreational needs were met whilst maintaining their independence as much as possible. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. EVIDENCE: The home provided a variety of activities within the home such as: • Board games, • Musical entertainment (on a monthly basis), • Exercise activities, • A seated ten pin bowling game, • Clothes shows, • Bingo • Pantomimes. • 3 monthly gardening activities are available which include an interactive show and potting plants • Coffee mornings • Video’s and DVD’s Films, etc. Close (The) DS0000019961.V297601.R01.S.doc Version 5.2 Page 13 Activities outside of the home include: • Town events • Day trips • Lunch outings • Mothers union • Christmas lunch Residents spoken with said that they enjoyed the entertainment at the home, and the results of a recent satisfaction questionnaire sent out to the residents had indicated that games such as bingo, skittles and dominoes were enjoyed. The home had an open visiting policy and residents spoken with confirmed that they were able to receive their visitors within their private accommodation if they chose to do so. Meals were provided at the following times; breakfast 8.30-9.30, Lunch 12.301.30, evening meal 5-6pm and supper – at a time convenient to each resident. The menus of the home rotated over a 28-day period. Two choices were offered at lunchtime meal, although it was confirmed with the cook that should a resident prefer an alternative to the choices on the menu then this would be provided. Residents spoken with were very complimentary about the meals and one resident said it was the best food he’d ever had and stated that he’d never eaten so well. Advocacy services were used by some of the residents, and information regarding advocacy services is displayed within the home for residents and their representatives if required. Close (The) DS0000019961.V297601.R01.S.doc Version 5.2 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 the following standard(s): 16,18 The homes complaints procedure is accessible to residents and the complaints log demonstrates that complaints are listened to and acted upon promptly. The homes practices promote the protection of residents from abuse. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The homes policy is clear, accessible and includes the stages and timescales that a complaint will be dealt with and responded to. The complaints log was seen and demonstrated that the complaints contained details of any investigation and the action that was taken. Residents spoken with confirmed that they new how to make a complaint and said that they would raise any concerns they had with the registered manager. The majority of staff had undertaken Adult Protection training at the home, however to further enhance residents’ safety all staff working at the home should undertake adult protection training. The homes Adult Protection procedure is in the process of being reviewed to ensure that it reflects Derbyshire’s local procedure to ensure a consistent approach is delivered regarding any adult protection issues, which will further promote and protect the welfare of the residents at the home. Close (The) DS0000019961.V297601.R01.S.doc Version 5.2 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 the following standard(s): 19,24,26 Residents live in a safe, clean and well-maintained environment, with their own possessions around them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: A tour of the building was undertaken and all areas seen appeared clean and private accommodation was attractively decorated and in keeping with each resident’s personal tastes and choice. Shared bedrooms were seen and provided adequate screening to ensure residents privacy could be maintained when required. The manager confirmed that although close circuit television cameras (CCTV) are in place within the home they are not in use. Close (The) DS0000019961.V297601.R01.S.doc Version 5.2 Page 16 A requirement left at previous inspections (standard 21) that the home should provide a sufficient number of baths and showers was not fully assessed on this occasion. The registered manager discussed and showed plans to adapt one bathroom (that could not be used by residents due to restricted access from all sides of the bath) into a shower room and toilet, with a partition wall that will also incorporate the existing toilet in a separate room. This will then provide 1 shower room and toilet and one separate toilet in place of the existing bath and toilet. This requirement had not yet reached the timescale given at the time of inspection. The laundry area was seen and found to be satisfactory and housing a washing machine with a sluicing facility, this ensures that laundry can be thoroughly washed and the risk of infection reduced. Residents spoken with said they felt the home was kept clean and tidy. All residents spoken with said they were happy with their private accommodation. Close (The) DS0000019961.V297601.R01.S.doc Version 5.2 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 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): 27,28,29,30 The numbers and skill mix of staff ensures the residents needs can be met by staff that have received the training required to undertake their jobs competently and the recruitment practices in place promotes residents safety and welfare. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. EVIDENCE: Sufficient staff are rostered on shift to enable the residents needs to be met. 75 of the care staff team have a National Vocational Qualification in care at level 2 or above which means that the home exceeds the national targets set. 2 staff files were seen and both had the required information in place regarding their recruitment. Although any gaps in employment had been identified on the application form and a full employment history had been given, it was noted that the application form didn’t request a full employment history or request that any gaps in employment be explained. To ensure that future applicants provide this information it is recommended that these requirements be clearly requested on the application form. Training for staff was ongoing and within the last 12 months staff have undertaken fire training, moving and handling, health and safety and food hygiene. Future training planned included dementia training, medication, infection control and first aid. One member of staff who had recently commenced employment at the home was undertaking induction training, this demonstrates that the home strives to Close (The) DS0000019961.V297601.R01.S.doc Version 5.2 Page 18 ensure all new staff are familiar with the principles of care, safe working practices and the particular needs of the resident group. Close (The) DS0000019961.V297601.R01.S.doc Version 5.2 Page 19 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): 31,33,35,38 The registered manager has the qualifications and experience required to run the home competently and ensures that residents’ views and opinions actively influence the way their home is run. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. EVIDENCE: The registered manager has been in post since September 2000 and managed another care home prior to this. She has a National Vocational qualification in care at level 3 and was at the time of this inspection in the last year of a business management qualification and had reached diploma level to date. Comments received from residents and staff regarding the registered manager’s management approach to the home was very positive. One member Close (The) DS0000019961.V297601.R01.S.doc Version 5.2 Page 20 of staff spoken with stated that the manager was always available for staff and residents and had an open door policy. Satisfaction surveys were sent out to residents and their representatives/relatives in April 2006. The results of this survey had been gathered and were to be put into the homes newsletter to inform residents and their relative. Residents spoken with confirmed that the home regularly sought their views and opinions and informed them of the outcome of any action or decisions that are made regarding their home. Residents meetings were held every six months, the manager stated that few residents became actively involved in these meetings. Discussions took place regarding the managers decision for each residents key worker to become further involved with their residents through seeking residents views on any changes or décor to their private accommodation, shopping required and discussions with residents to seek their opinions and general views. The key workers will then feedback this information to the manager on a monthly basis. No residents monies were kept at the home, any monies required was provided to residents and then reimbursed by the resident’s relative or representative. Accounts were in place to demonstrate monies owed and these were satisfactory. The homes health and safety records were found to be satisfactory, this included records of fire alarm tests, fire officers last visit, records of fire drill, servicing of gas and electrical appliances. Close (The) DS0000019961.V297601.R01.S.doc Version 5.2 Page 21 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 3 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 3 X 3 X X 3 Close (The) DS0000019961.V297601.R01.S.doc Version 5.2 Page 22 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. 2 Standard OP7 OP8 Regulation 15.2 (b) 14.2 Requirement Reviews and any changes in care plans must be clearly dated and signed. Risk assessments for pressure sores, nutritional screening, history of falls and moving and handling must be reviewed on a continuous basis to identify any changes and inform staff of the required action to be taken Additional night staff must undertake administration of medication training; to ensure that sufficient numbers of trained staff are available to administer residents prescribed medication as required during the night. Sufficient numbers of baths and showers must be available with hot and cold water supply. (Previous timescale 31.12.05) Not assessed on this occasion and timescale not reached at time of inspection. Timescale for action 30/08/06 30/08/06 3 OP9 13.2 30/08/06 4 OP21 23.2j 30/06/06 Close (The) DS0000019961.V297601.R01.S.doc Version 5.2 Page 23 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 OP7 Good Practice Recommendations Consideration should be given to the method of reviewing care plans in a format that is easily understood. Consideration should be given to the format used for documenting day-to-day issues regarding residents and weekly reviews to avoid the duplication or contradiction of records. All staff working at the home should undertake adult protection training to further promote and protect resident’s welfare. 3. OP18 Close (The) DS0000019961.V297601.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Close (The) DS0000019961.V297601.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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