Inspection on 18/08/05 for Corinthian House

This inspection was carried out on 18th August 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Corinthian House 16/08/06

Corinthian House 23/03/06

Corinthian House 05/11/04

Corinthian House 31/08/04

Corinthian House 25/03/04

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

CARE HOMES FOR OLDER PEOPLE Corinthian House Green Hill Lane Upper Wortley LEEDS LS12 4EZ Lead Inspector Sean Cassidy Unannounced 18 August 2005 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. Corinthian House J52 S1334 Corinthian House V242064 180805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Corinthian House Address Green Hill Lane Upper Wortley LEEDS LS12 4EZ 0113 279 9888 0113 279 9099 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) Corinthian Care Limited Graham Spencer Care Home with Nursing 70 Category(ies) of Old Age (70) registration, with number Terminally Ill (1) of places Corinthian House J52 S1334 Corinthian House V242064 180805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The place for Teminally Ill is for the service user specified in the application for variation dated 28 September 2004 Date of last inspection 5 November 2005 Brief Description of the Service: Corinthian House is a purpose built privately owned Care Home situated on Green Hill Lane, approximately 2.5 miles from Leeds City Centre. It is set in 1.5 acres of fully landscaped private gardens adjoining Western Flatts Park.Their philosophy of care is based upon the need to understand and respect persons as individuals at all times, with the benefit of care staff providing care and reassurance 24 hours a day.Corinthian House is located on three floors, with all floors being accessible by lift. They have a mixture of single and double rooms available on each floor, all with private en-suite facilities. All rooms are furnished to a good standard, with a call system, as well as television and telephone points to every room. In the park adjoining Corinthian House are two bowling greens, a cricket pitch and a delightful walled rose garden. Corinthian House J52 S1334 Corinthian House V242064 180805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out by one inspector and lasted a full day. The purpose of the inspection was to make sure the home was operating and being managed to a satisfactory standard. The inspector spoke to several service users and members of staff. A number of documents were examined which included care plans, policies and other records. What the service does well: What has improved since the last inspection? What they could do better: The home has recently undergone a recent takeover and the new providers are beginning to have a much clearer idea of the areas where improvements need to be made so that the home meets the National Minimum Standards. A new manager has been appointed to manage this process and she has already identified areas of priority to improve care provision. The following is a summary of things the home could do better: • More information needs to be made available to enable prospective service users make a choice of whether to move into the home or not. Existing service users must be provided with copies of the homes updated Service User Guide and a copy of their Terms and Conditions. An Updated Statement of Purpose must also be available. J52 S1334 Corinthian House V242064 180805 Stage 4.doc Version 1.40 Page 6 Corinthian House • Care plans must be reviewed to ensure that all residents care needs are being planned for and that staff caring for them are aware of what those needs are. Residents and their relatives must be more involved with the assessment, care planning and risk assessment process. More work needs to be carried out around residents daily life and social activities. Residents were clear that there is little on offer from the home with regards to providing recreation and leisure outlets. The resident assessment should be used to assess these needs and then appropriately planned for. The Staff must be appropriately trained in preventing and dealing with Adult Protection and Abuse. The policies and procedures must be written to incorporate local adult protection guidelines. Staff must to receive appropriate supervision as set out in the standard. All records must be locked away securely in accordance with the Data Protection Act. More intensive work must be carried out to ensure residents health and safety is properly protected. This includes ensuring staff receive mandatory training in areas such as Manual Handling, First Aid, Infection Control, COSSH and Moving and Handling. • • • 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. Corinthian House J52 S1334 Corinthian House V242064 180805 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 Corinthian House J52 S1334 Corinthian House V242064 180805 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) 1,2,3,5 Residents do not receive the necessary information that would help them make an informed choice about moving into the home. Trial visits are not consistently offered to residents. Residents do not receive Terms of Conditions or Contracts when they move in. Pre assessments are carried out that ensures the home can meet the residents’ needs. EVIDENCE: Due to the recent change in ownership of the home there have been problems with ensuring that prospective residents receive the necessary correct information to assist them with making an informed decision about moving into the home. The Statement of Purpose, Service User Guide, Contract and Terms and Conditions are not yet completed. The manager said these documents would be provided to all new and existing residents very soon. Residents spoken to were not familiar with these documents and don’t remember having the opportunity to visit the home prior to moving in. Corinthian House J52 S1334 Corinthian House V242064 180805 Stage 4.doc Version 1.40 Page 9 Evidence was found too show that the home does assess residents prior to moving into the home. Residents said that they were assessed prior to moving into the home and they were given assurances that the home could meet their assessed needs. Corinthian House J52 S1334 Corinthian House V242064 180805 Stage 4.doc Version 1.40 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) 7,8,10 More work is needed to ensure resident care plans meet the standard and that care needs are being met. Not all care staff are aware of the residents needs. Residents are happy with the way in which staff respect their privacy and dignity. But, providing locks on bedroom doors and lockable storage spaces could further reinforce this. EVIDENCE: The new manager has identified that the care plans provided to assist staff do not yet meet the standard. A process has commenced to re assess each resident and plan his or her care from that. An individual has been identified to lead this process and progress is being made. Those care files examined by the inspector identified that not all care needs identified in the assessments have a care plan in place to assist carers with meeting these need. Residents said that they are not involved with the care planning process and evidence was found in the files to show this did not happen. The care plans seen are reviewed monthly and some were altered to show changing needs. The carers spoken to were not familiar with the prescribed care and stated they rarely looked at the care plans. Corinthian House J52 S1334 Corinthian House V242064 180805 Stage 4.doc Version 1.40 Page 11 They were not aware of the residents care needs. Those resident plans that have been reassessed showed that the home ensure that risk assessments are carried out in areas such as Falls, Nutrition, Moving and Handling and Pressure Area Care. Residents that were identified as sustaining a fall did not have their risk assessments reviewed to further minimise the risk. One resident that was dependent on carers had a care plan stating the resident needed to be turned 3-4 hourly. There was no evidence to show this took place as the turns chart in the resident room had not been filled in for nearly three months. This was also the case for leg exercises that should have been carried out. All residents spoke very highly of the way in which the carers spoke to them and treated them.” I am treated with respect. The staff cannot do enough for me.” “My privacy and dignity is well respected.” Observations of staff during the inspection showed that they are very courteous and kind when dealing with the residents. Residents were very happy with the laundry service provided by the home. One resident asked that this be highlighted in the report as she was happy Some residents and relatives said that they would like the opportunity to have a lock on their bedroom door and also a key to a lockable space in their room. Bedroom doors are not lockable at present. This restricts residents’ privacy and dignity. Corinthian House J52 S1334 Corinthian House V242064 180805 Stage 4.doc Version 1.40 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) 12,13,15 The home does not ensure the residents’ lifestyles and expectations satisfy their social and recreational needs. Residents are enabled to maintain close contacts with family and friends. Mealtimes are a social event within the home and residents felt that the food was of a good quality. Some residents would like to see more fresh fruit available to them. EVIDENCE: The new assessment forms being used by the homes have a section for staff to fill in the likes and dislikes of the resident. This covers areas of interest and leisure. These documents were generally incomplete or had not been filled in. The residents said that there were very few activities provided in the home and they were unable to identify when they last had an opportunity to leave the home as part of a leisure activity. No up to date information was seen that told residents and relatives what activities or events were planned by the home. The manager has identified these issues and is seeking to employ an activities co coordinator to assist with meeting this standard. Resident were asked about their daily routines. The majority spoken to said that they got up very early and most were happy with this. Corinthian House J52 S1334 Corinthian House V242064 180805 Stage 4.doc Version 1.40 Page 13 But, two residents were quite adamant that they did not like getting up so early in the morning and would like this to change. The care plans for these residents did not have a sleep care plan where an agreement was obtained from the resident as to what their wishes were for going to bed and getting up. Residents and relatives said that they were very happy with the visiting arrangements and that they were able to meet in private if they wished. The inspector was able to have lunch with the relatives during the inspection. This meal was very much a social event and was very well attended by all residents on all floors. Residents thought their meals were of a good quality and they had opportunities to choose meals that they liked. Staff came to them the day before and asked them what they would like to eat the next day. Menus were displayed in the dining areas and the meals provided matched with the meals on the menu. Residents that needed assistance were seen to receive this from staff. Pureed meals were provided in individual portions for those that needed them. Staff were very pleasant and jovial during the meal time which was enjoyed by the residents. Some residents said that they didn’t get much fruit and that this would be nice, especially during the hot weather. Corinthian House J52 S1334 Corinthian House V242064 180805 Stage 4.doc Version 1.40 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) 16,18 The complaints procedure assures residents and their families that their complaints will be listened to and appropriately investigated. Residents are not sufficiently protected by the systems used to minimise the risk of Adult Abuse. EVIDENCE: The complaints procedure is displayed in the front entrance of the home and also on each floor. Residents said that they knew who to speak to if they wished to complain and that they felt their complaints would be listened to. The manager is committed to ensuring that all complaints are dealt with appropriately and evidence was seen to show this was the case. The homes recording system for complaints has improved since the last inspection. Carers are not trained in the area of Adult Protection and therefore residents are placed at risk with this omission. The manager is at present developing an Adult Protection Policy that is in line with local Adult protection guidelines. These local guidelines need to be obtained so that all staff can use them for reference in the event that an incident arises. The home and the local Adult Protection Unit have dealt with a recent Adult protection issue. The inspector identified a few areas where improvements must be made to ensure residents are appropriately protected. Corinthian House J52 S1334 Corinthian House V242064 180805 Stage 4.doc Version 1.40 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) none The above standards were not inspected during this visit. EVIDENCE: Corinthian House J52 S1334 Corinthian House V242064 180805 Stage 4.doc Version 1.40 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 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) 28,29, Residents appeared to be confident that they were in safe hands. There is a commitment to ensure at least 50 of care staff are trained to NVQ level 2 standard. Recruitment procedures used by the home to protect residents are good. EVIDENCE: The manager identified that the home is on course to ensure all staff are trained to at least NVQ level 2 by the end of 2005. Residents said that they had no concerns regarding the confidence they had in the staffs ability to care for them and were confident that the staff knew what they were doing. The staff files seen showed that the home has adopted a good system for ensuring they obtain all the necessary information for an employee before they can commence working. Corinthian House J52 S1334 Corinthian House V242064 180805 Stage 4.doc Version 1.40 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 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) 31,36,37,38. The manager is well experienced and working towards obtaining the recommended qualifications for the role. More intensive work is required to ensure the Health and safety of Service Users is protected. EVIDENCE: The manager has only just very recently come into post. This is not her first management position as she has worked in a number of different positions. She is a Registered Nurse and has just recently completed NVQ Level 4 in management and is awaiting the results. The staff and residents know who the manager is and that it will take a little bit of time for her to settle into the new position. The manager has already carried out a mini audit of the home and has consulted with a number of staff and residents regarding their views of the home. It was evident from speaking to the relevant groups within the home that the manager adopts an open and inclusive atmosphere. Corinthian House J52 S1334 Corinthian House V242064 180805 Stage 4.doc Version 1.40 Page 18 The manager gave assurances that any areas where she identified that the standards were not being met would be improved. Records were not being appropriately locked away as personal information belonging to the residents was being stored in a cupboard in a room that had no lock. Staff spoken to were not clear about supervision and said that they did not think they have received any recently. The manager who has already identified this shortfall verified this. Although the home was clean and tidy the domestic staff need trained in areas such as Infection Control and Controlling Substances Harmful to Health. Some cleaning techniques used in the home left residents susceptible to infection. This was pointed out to the manager. The homes records of mandatory training were not available and it was identified that quite a number of staff have not received this. Environmental risk assessments, although carried out, were not in the home for use. Hot water temperature checks, bed rails checks and other equipment checks could not be produced. The five-year electrical wiring certificate was also not in place and PAT testing of electrical equipment had not been done. The manager gave assurances that these would be carried out as soon as possible. Corinthian House J52 S1334 Corinthian House V242064 180805 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 x 2 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 x 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 x x x x 2 2 1 Corinthian House J52 S1334 Corinthian House V242064 180805 Stage 4.doc Version 1.40 Page 20 yes 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. Standard 1 1 Regulation 4 5 Requirement The registered person must make avilable an up to date Statement of Purpose. The registered person must ensure that residents are provided with an up to date Service User Guide at the point of moving into the home.. Each resident must be provided with a Statement of Terms and Conditions or a Contract at the point of moving into the home. The registered person must ensure the care plan is drawn up with the resident The care plans must clearly set out in detail the action that should be taken to ensure all residennts care needs are met. The registered person must ensure that locks are fitted to residents bedroom doors to ensure their privacy and dignity is respected. the registered person must ensure that prescribed care is appropriately administered.( This is regarding pressure area care and excercises.) the registered person must ensure that routines of daily J52 S1334 Corinthian House V242064 180805 Stage 4.doc Timescale for action 30 September 2005 30 September 2005 31 november 2005 31 November 2005 31 November 2005 31 January 2005 3. 2 5 4. 5. 7 7 15 15 6. 10 12 7. 8 12 31 October 2005 8. 12 16 31 October 2005 Page 21 Corinthian House Version 1.40 9. 10. 12 18 12 12 11. 12. 13. 36 37 38 18 17 12 14. 38 12 living are flexible and suit resident needs. ( This refers to sleep care plans. ) The registered person must record and provide for the leisure interest of residents. the rgistered person must ensure that all residents are safeguarded against possible abuse. Carers must receive formal supervision at least six times a year. Individual records held on residents must be securely locked away. the registered person must ensure the Health and safety of residents is appropriately protected. The registered person must supply the Commission with a copy of the 5 year electrical wiring certificate. 31 October 2005 30 September 2005 30 November 2005 30 September 2005 30 September 2005 30 September 2005 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. Refer to Standard 5 10 12 28 Good Practice Recommendations The registered person should ensure prospective service users are invited to visit the home prior to moving in. Residents should be provided with lockable storage space for medications, valuables and money. The registered person should provide service users with up to date information of about activities and events. A minimum of 50 of staff must be trained to NVQ Level 2 or above by the end of 2005. Corinthian House J52 S1334 Corinthian House V242064 180805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Aire House Town Street Rodley, LEEDS LS13 1HP 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 Corinthian House J52 S1334 Corinthian House V242064 180805 Stage 4.doc Version 1.40 Page 23 - 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. 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