CARE HOMES FOR OLDER PEOPLE
Connolly House Reynolds Avenue Whiteleas Estate South Shields Tyne and Wear NE34 8JP Lead Inspector
Mr Clifford Renwick Unannounced Inspection 20th December 2005 9:35 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 Connolly House DS0000037959.V270526.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. Connolly House DS0000037959.V270526.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Connolly House Address Reynolds Avenue Whiteleas Estate South Shields Tyne and Wear NE34 8JP 0191 5361527 0191 5361527 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) South Tyneside MBC Eileen Foster Care Home 36 Category(ies) of Dementia - over 65 years of age (36), Learning registration, with number disability (1) of places Connolly House DS0000037959.V270526.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service may from time to time admit persons between the ages of 60 and 65 years of age with Dementia. The LD service user category relates to a service user presently residing at Connolly House. 8th September 2005 Date of last inspection Brief Description of the Service: Connolly House is a purpose built home situated in the centre of a housing estate. It is close to all local amenities and forms part of the local community. Next-door is a Local Authority Day Centre where service users have the opportunity to meet people, maintain links with the local community and join in with a wide range of activities should they wish. The home, owned by South Tyneside Local Authority has undergone recent variation to service user categories. It provides 36 places for Dementia over 65 years of age. The home does not provide nursing care. The home is divided into 4 wings (living areas). Wing 1 offers permanent care to 6 older people and also includes 3 beds for short break services. Making a total of 9 beds. Wing 2 consists of 9 beds and is currently unoccupied and it is the intention of the authority to use this wing to provide permanent care to service users with a diagnosed dementia. Wings 3 & 4 offers permanent accommodation to 18 service users who have a dementia type illness. A central independent area of the home provides a day care service for a maximum of 12 persons over a 7- day period and this is operated in partnership with the Alzheimers Society. All of the units are self-contained with lounges, small conservatories dining rooms, kitchenettes, bathrooms toilets and garden areas. There is a large reception area and separate smoking lounge with an activities area. Centrally are the kitchen and laundry facilities. Connolly House DS0000037959.V270526.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 7 hours and was carried out as part of the statutory twice-yearly inspection process. All communal areas of the premises were viewed and care records were examined as well as records that related to health and safety and new staff employed in the home. Discussion took place with the staff on duty and also with several residents and families who were visiting the home at the time of the inspection. Time was spent observing staff practices. It was established that people who live in this home prefer to be known as residents; therefore this term of reference is used throughout the report. The judgements made are based on the evidence available on the day of the inspection. What the service does well:
Good training opportunities continue to be available to staff and this ensures residents are cared for by a well-trained staff group. Discussion with residents confirmed that they are satisfied with the services offered in the home. Residents spoke of the food and the meals that are provided stating that they were as good as those provided in a restaurant. A good rapport was evident between staff and residents and this contributed to a pleasant atmosphere. The staffing ratios in place are good and this means that staff have a lot of time to spend with residents. This ensures that residents receive the individual level of care that they need on a personal basis. The atmosphere in the home is vibrant and a lot was going on in the way of activities. Observations confirmed that residents were able to choose from a range of activities what they wanted to do and staff supported this. A range of written documentation is in place, which relates to the care services offered and this is maintained in a satisfactory manner. The building is well maintained and offers a good homely environment for residents to live in. Connolly House DS0000037959.V270526.R01.S.doc Version 5.0 Page 6 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. Connolly House DS0000037959.V270526.R01.S.doc Version 5.0 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 Connolly House DS0000037959.V270526.R01.S.doc Version 5.0 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 The admissions process ensures that prospective resident’s needs are assessed prior to care being offered. This helps to ensure that residents are offered the right type of care at the home and also ensures no one is admitted inappropriately. EVIDENCE: Three case files for residents were examined and these contained a comprehensive assessment in respect of each resident. The social worker and also the homes staff had completed assessments. Discussion with the acting manager confirmed that an assessment is always completed prior to an admission being agreed. The homes staff when compiling their assessment visit the prospective resident in their own environment, which may be hospital dependent upon their individual circumstances. Staff use the assessment to identify whether any specialist equipment is required should the person move into the home. And also whether staff requires any specialist training. In addition to the assessment of needs a risk assessment is also completed and this leads to any special measures being put in place to ensure residents safety. Connolly House DS0000037959.V270526.R01.S.doc Version 5.0 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): 7, 8, 9, 10 The Health and personal care needs of resident’s based on their care plans are met in a way that treats them with respect and promotes their rights and privacy. The homes procedures for storing and administering medication are sufficiently robust to safeguard residents. EVIDENCE: Further developments have taken place with the written care plans for residents and these are still in the process of being developed further. Two care plans were viewed and I offered advice as to how these could be developed further. In their current format they are much improved and offer staff clear guidance as to how specific care needs are to be met. The residents have access to all services provided by the NHS and good links are evident with local GP’s and community nurses. A record is maintained in resident’s file of all contact that is made with health professionals. In addition to this daily records that are kept offer a picture of day-to-day life in the home and whether there are any concerns about health. Advice was offered about the type of recordings kept and how these could be improved.
Connolly House DS0000037959.V270526.R01.S.doc Version 5.0 Page 10 Appropriate polices and procedures are in place for the receipt, administration and disposal of medicines. Two residents are supported by staff to administer their own medication and have appropriate lockable facilities in their bedrooms. The home is introducing a new monitoring dosage system in conjunction with the local pharmacist and this was due to start on the week of the inspection. Good records are in place for the medication in use and this also includes a file that lists the description of medicines in use and also any possible side effects. This assists staff in increasing their knowledge of medicines. Connolly House DS0000037959.V270526.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14 The residents are able to follow their own daily routines, which satisfy their social and religious needs, and there are opportunities to take part in social activities on a daily basis. Friendships and relationships with people outside the home are encouraged and this ensures that residents are able to maintain good contact with relatives and friends. EVIDENCE: Individual care plans identify resident’s interests and how they wish to spend their time in the home. It was evident from observations that residents are involved in choosing what they wish to eat and also whether they wanted to take part in activities. A range of activities was on offer, which varied from dominoes, colouring in, listening to Christmas music and watching an old style film on television. Due to the level of dementia that residents experience not everyone is able to make a choice so staff use information collected as part of the assessment process to determine what they would like to do. A Christmas lunch had been held a week ago and this involved resident’s families coming to the home to have a meal. Discussions with staff confirmed that this had been a positive experience with 28 visitors coming into the home for the meal. Connolly House DS0000037959.V270526.R01.S.doc Version 5.0 Page 12 There are no restrictions on visiting the home and throughout the inspection there was a steady stream of visitors to the home many of whom were bringing in gifts for the resident’s and staff. Connolly House DS0000037959.V270526.R01.S.doc Version 5.0 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 the following standard(s): None of these standards were assessed on this occasion. EVIDENCE: Connolly House DS0000037959.V270526.R01.S.doc Version 5.0 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 the following standard(s): 19, 21, 22, 25, 26 The home is clean, warm and well maintained offering residents a homely and safe environment in which to live. Resident’s bedrooms, communal areas and bathing/WC facilities are accessible to meet resident’s mobility needs. Specialist equipment is available to maximise resident’s independence. The lighting in some communal areas is poor and consequently could have an impact on those service users who have a visual impairment. Unboxed pipe work in bathrooms could present a health and safety hazard for residents. Recent outbreaks of sickness and diarrhoea have resulted in new working procedures being implemented for staff, however these are not available as written procedures. Connolly House DS0000037959.V270526.R01.S.doc Version 5.0 Page 15 EVIDENCE: All communal lounges and dining rooms are clean and tidy and furnished to a good standard. One bedroom had an odour which staff were aware of and as such had implemented special cleaning measures. A new specialist bath has been delivered to the home but is waiting to be connected to a hot and cold water supply. Pipe work in bathrooms as identified in the last two inspection reports is not boxed off and this means that it is possible for residents to touch hot pipes. The acting manager was aware of this and confirmed that requests have been made to the authorities estates department to deal with this. Lighting which was also commented on in previous inspection reports has not been fully completed by the estates department. Though some improved lighting has been provided to the front of the home and also in the day centre. Specialist equipment is available for those resident’s who have been assessed as requiring it. There have been three outbreaks of sickness and diarrhoea since September, which has affected both residents and staff. The home has sought advice from the public health officer and has implemented a set of procedures to be used by staff as a way of controlling infection. In discussion with the acting manager it was confirmed that all staff had been informed verbally of what actions they must take when dealing with soiled linen. Staff were working to guidance notes issued by the public health officer and the acting manager had ensured that appropriate protective clothing and anti/bacterial hand washes are available. Connolly House DS0000037959.V270526.R01.S.doc Version 5.0 Page 16 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): 29, 30 The staff recruitment procedures protect the residents. A well-trained staff team meets the resident’s needs. EVIDENCE: Good recruitment practices are in place and the acting manager is involved in making sure that each staff member has a personnel file, which confirms that all of the necessary documentation required for recruitment is in place. One new member of staff had commenced work in the home the day before the inspection. This person had recently applied for the position in the home and was previously working in another of the authorities care homes. Consequently this meant that the home is waiting for his personnel file to be transferred. Good training opportunities are available to the staff and the training file confirmed that staff had completed a range of training courses. Training that has been covered includes challenging behaviour, fire awareness, activities, first aid and clean food handling. It was confirmed in discussion with the acting manager that staff would also be covering manual handling. It was also stated that most of the staff team had completed training in infection control. Connolly House DS0000037959.V270526.R01.S.doc Version 5.0 Page 17 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): 35, 38 Appropriate records are maintained that confirm that resident’s personal allowances are dealt with satisfactorily. The resident’s health and safety is promoted by a well managed home. However, there are some areas of potential risk to resident’s and staff, which need to be addressed by the implementation of written procedures that deal with infection control EVIDENCE: Good records are maintained for personal allowances held on behalf of residents with receipts being obtained for all transactions. Regular balance checks of monies held are carried out each time a senior member of staff changes shift and this ensures that resident’s monies are safeguarded.
Connolly House DS0000037959.V270526.R01.S.doc Version 5.0 Page 18 Due to recent outbreaks of sickness and diarrhoea the staff have tightened up on procedures in the home in order to prevent infection. This has resulted in a range of extra measures for dealing with laundry and cleaning in the house. Additional measures are also in place to carry out specialist cleaning in one bedroom due to a resident contracting an infection while in hospital. The acting manager has carried out risk assessments and these need to be developed further into written procedures for staff to follow. Connolly House DS0000037959.V270526.R01.S.doc Version 5.0 Page 19 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X 2 3 X X 3 3 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 3 Connolly House DS0000037959.V270526.R01.S.doc Version 5.0 Page 20 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. 2. Standard OP7 OP7 Regulation 15 15 Requirement Care plans must continue to be developed as advised during the inspection. For those residents assessed as being at risk of dehydration. Fluid balance charts must be implemented as part of the care plan. The assisted bath, which has been provided, must be connected to a hot and cold water supply. Exposed pipe work must be boxed in order to prevent the risk of scalding.(Outstanding since 28/02/05) The upgrading of the lighting in communal areas must continue. (Outstanding since 08/09/05) Written procedures must be implemented which demonstrate the measures in place to deal with the control of infection. Timescale for action 30/06/06 20/12/05 3. OP21 23 31/01/06 4. OP25 23 31/01/06 5. OP25 13 (4) C 31/03/06 6. OP38 16 (2) (j) 20/12/05 Connolly House DS0000037959.V270526.R01.S.doc Version 5.0 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Connolly House DS0000037959.V270526.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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