CARE HOMES FOR OLDER PEOPLE
The Close Care Home 20 North Avenue Ashbourne Derbyshire DE6 1EZ Lead Inspector
Vanessa Davies Unannounced 5 September 2005 10.00am
th 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. The Close Care Home C52-C02 S19961 The Close V237545 050905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Close Care Home Address 20 North Avenue Ashbourne Derbyshire DE6 1EZ 01335 345228 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) Mr Hugh Marcus Thornely Gibson Parwich Hospital Trust Mrs Donna Bradley Care Home with Personal Care 15 places Category(ies) of 15 Older People registration, with number of places The Close Care Home C52-C02 S19961 The Close V237545 050905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None. Date of last inspection 21.02.05 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 Close Care Home C52-C02 S19961 The Close V237545 050905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced. The manager has been on maternity leave for a while and returned back to work this week. She called into the home towards the end of the inspection. Information for this report was gathered by reading records, observing staff with residents, speaking with residents and the manager. What the service does well: What has improved since the last inspection? The Close Care Home C52-C02 S19961 The Close V237545 050905 Stage 4.doc Version 1.40 Page 6 At the previous inspection no requirements were left and only one recommendation. The manager had addressed the recommendation left. 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. The Close Care Home C52-C02 S19961 The Close V237545 050905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Close Care Home C52-C02 S19961 The Close V237545 050905 Stage 4.doc Version 1.40 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 standard(s) 3,4,6 Detailed assessments provide staff with information to enable them to meet residents needs, however incomplete assessments could potentially mean residents needs are not being met. EVIDENCE: Each file examined had a detailed assessment of need or transfer form from previous place. There was evidence of input from the resident or relative. One file had 6 monthly reviews with details of any changes. Although the second file had a transfer form completed by the hospital, the homes assessment had a number of incomplete areas, no name, date of birth or age. The manager has returned from maternity leave this week and therefore the assessment was completed by a care worker. The home provides access to relevant professionals as necessary. Specialist equipment needed is provided. The home does not currently provide intermediate care. The Close Care Home C52-C02 S19961 The Close V237545 050905 Stage 4.doc Version 1.40 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 standard(s) 7,8,9,11 The health needs of the residents are clearly met by a number of professionals. The poor administration of medication potentially places residents at risk. EVIDENCE: Each of the files examined had information about residents likes and dislikes. A range of activities are offered to meet social needs. Relatives and friends visit throughout the day without restriction and are always made to feel welcome, some staying for a meal. Residents records evidenced input from a variety of health professionals. The GP completes medication reviews on regular occasion. The District Nurse visits regularly and there was evidence of Flu vaccinations. The medication records were not examined, however the inspector did observe medication being administered. Medication was given to the resident, however the resident was not observed taking it. The staff member signed for the medication prior to administration. When taking medication to the resident the drug trolley was left unattended, open and easy to access as it was left by an open front door.
The Close Care Home C52-C02 S19961 The Close V237545 050905 Stage 4.doc Version 1.40 Page 10 Each of the files examined had no documented information relating to the residents wishes in the event of terminal illness and death. The Close Care Home C52-C02 S19961 The Close V237545 050905 Stage 4.doc Version 1.40 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 standard(s) 12,13,15 Dietary needs of residents are well catered for with a balanced and varied selection of food available. Activities and community access enable residents to maintain positive links with family and friends. EVIDENCE: Residents spoken with are happy living at the home. There are a range of activities on offer for residents; musical entertainment on a monthly basis, 1 resident paints with water colours another resident has a small exercise machine. The manager intends to introduce an, ‘old’ movies afternoon and to contact a gardener who works with residents on a quarterly basis if they wish. It was clear on the day of inspection that relatives and friends visit and are made to feel welcome. If residents are able to, they access the community independently; one resident the inspector met does go into the town of Ashbourne regularly. The residents are offered a varied and wholesome diet. The cook keeps a record of foods offered, a 4-week rolling menu, she also keeps a record of any changes to the menu.
The Close Care Home C52-C02 S19961 The Close V237545 050905 Stage 4.doc Version 1.40 Page 12 The Close Care Home C52-C02 S19961 The Close V237545 050905 Stage 4.doc Version 1.40 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 standard(s) 16,18 The complaints process at the home is available to residents ensuring that they aware of how and whom to complain to, however complaints are not documented and therefore no evidence is available to support residents are listened to. EVIDENCE: The member of staff on duty at the beginning of the inspection was unable to find the complaints file. The manager arrived later and stated that they had never had any complaints therefore there was no file. The manager must ensure that any issues raised by residents are documented. The inspector is aware of 2 complaints raised, which are not documented. 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 current procedure refers to NCSC this needs to be changed to CSCI. The home has an Adult Protection procedure in place with an excellent flowchart, however part of the procedure stated that the Senior carer will investigate the allegation, this must be reviewed and the manager must ensure that the policy reflects that of the Derbyshire Adult Protection policy. Again any referral to NCSC must be changed to CSCI. The Close Care Home C52-C02 S19961 The Close V237545 050905 Stage 4.doc Version 1.40 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 standard(s) 19,21,26 The home is clean and retains many of its original features, providing residents with an attractive homely environment. EVIDENCE: The home was very clean and tidy on the day of inspection. The home appeared to offer a safe environment, however one file examined stated that the resident was presented a wandering risk and a keypad door lock had been fitted. On the day of inspection, it was very warm and the door was wedged open throughout the inspection, presenting a risk to the resident who may wander. The home has recently been assessed by an Occupational Therapist (OT), the home has 2 baths however one is not currently used as residents are not able to get in or out, the OT has recommended it be changed to a level access shower. The home must provide more than 1 bathroom for the number of residents registered for. The manager stated that the providers had been made aware of the situation.
The Close Care Home C52-C02 S19961 The Close V237545 050905 Stage 4.doc Version 1.40 Page 15 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 Staff morale appears to be good resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life. EVIDENCE: The inspector was not able to fully examine this area as the manager was not on duty but called into the home and did not have access to files needed. The duty rota detailed 3 care staff throughout the morning and 2 care staff throughout the afternoon, with 1 waking night staff and 1 sleep-in care staff. There is a cook at the home and a domestic has recently been appointed. The staff on duty had a good relationship with the residents and visitors. The Close Care Home C52-C02 S19961 The Close V237545 050905 Stage 4.doc Version 1.40 Page 16 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) 37,38 The Close is normally a well managed home, however it has clearly missed the manager over the past few months and this is reflected in the report. EVIDENCE: The inspector did not fully assess this area on this occasion as the manager had only just returned from maternity leave. Records examined had evidence of inappropriate language, this was discussed with the manager who stated she would deal with the member of staff concerned. All records are kept in the office. Policies and procedures are available in the home, complaints and adult protection need to be updated as indicated earlier in this report. The fire alarm is tested weekly, however there was no evidence of it being tested since 05.08.05. The alarm system was inspected 15.11.04.
The Close Care Home C52-C02 S19961 The Close V237545 050905 Stage 4.doc Version 1.40 Page 17 The hoist was serviced March 05 and the landlords gas certificate dated 18.05.05. Staff record accidents in the accident record, however on one occasion, details in a residents file were that she fell to her knees, there was no accident record for this. The Close Care Home C52-C02 S19961 The Close V237545 050905 Stage 4.doc Version 1.40 Page 18 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 3 3 x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 x 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 x 2 x x x x 2 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 Standard No 16 17 18 Score 2 x 2 x x x x x x x x The Close Care Home C52-C02 S19961 The Close V237545 050905 Stage 4.doc Version 1.40 Page 19 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. 2. 3. Standard 9 11 16,37 Regulation Requirement Timescale for action 31.10.05 31.12.05 31.12.05 4. 5. 21 38 6. 38 13.2, 13.4 Arrangements must be made for c the safe handling, administration and recording of medication. 12.3 The wishes and feelings of the resident must be taken into account 17.2 Sch A record of complaints made by 4 (11) residents, representatives and staff must be kept, along with the investigative notes and response. 23.2 j Sufficient numbers of baths and showers must be available with hot and cold water supply. 23.4 c v Adequate arrangements for reviewing fire precautions and testing fire equipment at suitable intervals must be made. 17.1 a A record of any accident Sch 3 affecting a resident must be (3)(j) kept; including the nature, date, time & whether medical treatment was needed. 31.12.05 31.10.05 31.10.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. The Close Care Home C52-C02 S19961 The Close V237545 050905 Stage 4.doc Version 1.40 Page 20 No. 1. 2. 3. 4. Refer to Standard 11 16,18,37 18,37 37 Good Practice Recommendations Information relating to residents wishes in the event of death should be documented. The referral in the procedure to NCSC should be changed to CSCI The procedure should be reviewed to ensure it reflects what the Derbyshire Adult Protection procedure indicates. Staff should document residents records appropriately. The Close Care Home C52-C02 S19961 The Close V237545 050905 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection South Point, 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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