CARE HOMES FOR OLDER PEOPLE
Close (The) 20 North Avenue Ashbourne Derbyshire DE6 1EZ Lead Inspector
Vanessa Davies Unannounced Inspection 10.00 21 February 2006
st 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.V281527.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. Close (The) DS0000019961.V281527.R01.S.doc Version 5.1 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.V281527.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 5th September 2005 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. Close (The) DS0000019961.V281527.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and the Registered manager was on a training day. Information for this inspection was gathered by speaking with service users, a relative, staff, reading records and observing staff working with the service users. What the service does well: What has improved since the last inspection? What they could do better:
When needs are highlighted within the assessment of need the manager should ensure that a care plan and or a risk assessment is completed in order to meet the need. Medication records should be pre-printed wherever possible, hand written entries should be signed by the GP or 2 members of staff. Policies and procedures should be reviewed to reflect the changed from NCSC to CSCI a year ago. Close (The) DS0000019961.V281527.R01.S.doc Version 5.1 Page 6 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.V281527.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 Close (The) DS0000019961.V281527.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 Detailed assessments of need ensure that the home has the ability to meet the needs of residents moving into the home. EVIDENCE: 2 residents files were examined, both of the files were for residents who had recently moved to the home. There was evidence of a detailed assessment of need, although it was clear from some of the information detailed that the residents or relatives had been involved, however there was no documentary evidence. The care plans were developed on admission in November 2005 and had not been reviewed since that time. There were areas within the assessment, which highlighted needs, however care plans had not been developed to meet these needs. Close (The) DS0000019961.V281527.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): 9,10 Mutual respect and respecting privacy and dignity promotes a positive work and home environment. Detailed policies and staff training in administration of medication ensures that medication is administered safely, however hand written entries could potentially put residents at risk. EVIDENCE: Medication records examined had hand written entries without signatures. There were no details on the reverse of the medication sheet giving reasons why medication was not administered. Residents spoken with felt that all staff respected their dignity and privacy. This was evident on the day off inspection whilst observing staff working with the residents. Close (The) DS0000019961.V281527.R01.S.doc Version 5.1 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): EVIDENCE: All key standards within this area were assessed at the previous inspection and were therefore not assessed on this occasion. Close (The) DS0000019961.V281527.R01.S.doc Version 5.1 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): The complaints process at the home is available to residents ensuring that they aware of how and whom to complain to, a record of complaints and responses is kept ensuring that residents are listened to. EVIDENCE: There is a policy in place to ensure that complaints are addressed appropriately and residents spoken with were confident that any issues they. raised would be dealt with, by the manager. The member of staff spoken with on the day of inspection was aware of the complaints procedure and documentation needing to be completed in the event of a complaint being made. Close (The) DS0000019961.V281527.R01.S.doc Version 5.1 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): EVIDENCE: Key standards within this area were assessed at the previous inspection and were therefore not assessed on this occasion. Close (The) DS0000019961.V281527.R01.S.doc Version 5.1 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): EVIDENCE: Relevant key standards were assessed at the previous inspection and therefore not assessed at this inspection. Close (The) DS0000019961.V281527.R01.S.doc Version 5.1 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): EVIDENCE: Relevant key standards were assessed at the previous inspection and therefore not assessed at this inspection. Close (The) DS0000019961.V281527.R01.S.doc Version 5.1 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Close (The) DS0000019961.V281527.R01.S.doc Version 5.1 Page 16 Are there any outstanding requirements from the last inspection? YES 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 OP21 Regulation 23.2j Requirement Sufficient numbers of baths and showers must be available with hot and cold water supply. (previous timescale 31.12.05) Timescale for action 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP3 OP37OP18 OP16 OP18 OP9 OP9 Good Practice Recommendations The manager should ensure that care plans are developed to meet needs highlighted within the assessment. The referral in the policies and procedures to NCSC should be changed to CSCI. The procedure should be reviewed to ensure it reflects what the Derbyshire Adult Protection procedure indicates. All hand written entries on the medication charts need to be signed. It is recommended that a sample of staff signatures is kept at the front of the medication file. Close (The) DS0000019961.V281527.R01.S.doc Version 5.1 Page 17 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
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