CARE HOMES FOR OLDER PEOPLE
Corinthian House Green Hill Lane Upper Wortley Leeds Yorkshire LS12 4EZ Lead Inspector
Sean Cassidy Unannounced Inspection 23rd March 2006 09:30 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 Corinthian House DS0000001334.V285678.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. Corinthian House DS0000001334.V285678.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Corinthian House Address Green Hill Lane Upper Wortley Leeds Yorkshire LS12 4EZ 0113 2799888 0113 2799099 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) Corinthian Care Limited Mrs Jillian Shearer Care Home 70 Category(ies) of Old age, not falling within any other category registration, with number (70) of places Corinthian House DS0000001334.V285678.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th August 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 DS0000001334.V285678.R01.S.doc Version 5.1 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, relatives and members of staff. A number of documents were examined which included care plans, policies, procedures and other records. What the service does well:
The registered manager and staff have worked hard to improve the quality of care provided. The home communicates well with prospective residents and their families to assist them with making their choice to accept a place. Visiting professionals also feel that the home communicates well with them in an attempt to ensure the continuity of resident care is maintained. Service users and their families said the staff are very pleasant and helpful. They always have a welcome for them and make them feel at home. The grounds are attractive and well maintained, providing access for service users when weather permits. Residents and relatives said the standard of cleanliness is good. This was evidenced during the inspection. The improvements made by the manager and the whole staff team has improved care provision and staff morale. Residents, staff, relatives and visiting professionals, observed this. Corinthian House DS0000001334.V285678.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
There are areas that still need more work but if the improvement continues the home should be able to meet the targets that have been set. It has been recognised that improvements have been made with assessment, care planning and risk assessments. However, there were some areas of concern identified where care provision could not be evidenced. This related to some residents with pressure care needs. This was highlighted at the previous inspection and must be improved. The home must ensure that the residents or their representatives are involved with agreeing to the care plans and risk assessments developed for them. Self medication risk assessments must be developed to assist the resident group to self medicate if they so wish. This is particularly relevant to the residents receiving Intermediate care. The home is in the process of choosing appropriate locks for residents’ doors. By having these in place the home will further assist the resident group with their right to privacy and dignity when possible.
Corinthian House DS0000001334.V285678.R01.S.doc Version 5.1 Page 7 The provision of suitable activities and social events continues to be an area that the home has difficulty providing to residents. It is recognised that a new activity coordinator has just been appointed. It is recommended that she be assisted to fully develop her role so that she is able to meet this need for all residents. Although basic Adult Protection training is provided to the staff group from the manager, a person trained in this area must provide training. Two staff now have received this training and the home must now ensure that a process is in place to ensure all staff receive it. The manager recognises that there are areas of training that staff need to be improved. It was confirmed that supervision, appraisal and training needs analysis would assist this process. 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 DS0000001334.V285678.R01.S.doc Version 5.1 Page 8 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 Corinthian House DS0000001334.V285678.R01.S.doc Version 5.1 Page 9 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): 1,2,6. The home provides prospective residents and their families with substantial up to date information that assists them to make a choice about choosing a room. Good information is also provided to the resident when they move in. The standard of intermediate care provided to residents helps to maximise the their independence and assist them in their goal of moving back home. EVIDENCE: The Statement of Purpose and Service Users Guide have been redesigned by the home and includes all the necessary information needed to ensure all parties are kept well informed and up to date. All residents are now provided with a copy of the Service User Guide and both documents are found at the entrance of the home and also at the entrance to each floor. New residents and family representatives praised the staff of the home regarding the information they were provided with when they looked around. Residents and relatives confirmed that they did have the ability to visit the home prior to moving in. One relative said, “If I was given the opportunity to choose a home for my mum again, I would still choose Corinthian House.”
Corinthian House DS0000001334.V285678.R01.S.doc Version 5.1 Page 10 Terms and Conditions are provided to the majority of the residents living at the home. The manager agreed that those residents receiving Intermediate Care would also receive a copy. It was recognised that this was a small oversight of the manager and assurances were given that all residents will now receive a copy. This will be examined at the next inspection. There is a good Intermediate Care service provided within the home. Dedicated equipment and areas are provided to assist the residents meet their optimum levels of independence prior to moving back into their own homes. Staff receive training from the Intermediate Care Team and also from other sources provided by the home. A senior member of the Intermediate Care team spoke very highly of the staff at Corinthian House and praised their commitment and care provision to that resident group. Corinthian House DS0000001334.V285678.R01.S.doc Version 5.1 Page 11 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 home has made positive improvements with care planning and risk assessment. They are actively progressing towards ensuring the health, social and personal needs of the residents are being met. Residents are happy with the way in which staff respect their privacy and dignity. However, providing locks on bedroom doors could further reinforce this. EVIDENCE: Five care plans were inspected during the course of the inspection. Improvements have been made with the standard of care planning provided by the home. Each individual had been reassessed and a care plan had been provided for an identified care need. However, the documentation did not show that the residents or their representatives are being involved with the development of these documents. Residents are thoroughly risk assessed in relevant areas.
Corinthian House DS0000001334.V285678.R01.S.doc Version 5.1 Page 12 The manager and staff have worked hard to improve the care planning and risk assessments used by the home. The care plans consistently showed that where a care need was identified a care plan was developed. The manager identified from her audit that the nutritional status of the resident group was an area that the home should review and attempt to improve using appropriate risk assessment and guidance. After appropriate consultation, that included a local dietician and the home cook, positive changes have been made in an attempt to ensure resident nutrition is constantly monitored. Concerns were raised however with regard to the standard of care provided to those residents with identified pressure sores and at high risk of developing pressure sores. These care plans did not contain the necessary information needed so that staff could provide the necessary intervention to prevent tissue breakdown. Not all residents that are bed bound had records kept in their rooms to show staff provided the appropriate care. Residents were observed to be well cared for. Their clothes appeared well laundered and their hair was well kept. Residents said that the hairdresser called regularly and they enjoyed getting their hair done, as it was a social occasion. The manager is presently in discussion with the local Primary Care Trust in an attempt to get residents seen by a NHS dentist. The home has a thorough medication policy in place. They have recognised that they need to develop a self-medication risk assessment to assist those wishing to self medicate. This is particularly relevant to those residents receiving the intermediate care service. Consultation is currently taking place regarding this issue. 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 in all areas of the home 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. A relative asked to highlight that she was unhappy with the condition of some of the clothing that was returned from the laundry and that they agreed with the home that they would wash their relatives clothes at home. The relative asked if we would relay the fact that they were concerned that the underwear returned from the laundry was in a poor condition. This was concern was brought to the attention of the manager and she agreed to look into the matter. Some residents and relatives said that they would like the opportunity to have a lock on their bedroom door. This was highlighted at the last inspection and it was confirmed that the organisation is presently identifying the correct locks, which they are going to put on the doors. Residents are now provided with lockable space for valuables. Corinthian House DS0000001334.V285678.R01.S.doc Version 5.1 Page 13 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): 12,14 The home does not ensure the residents’ lifestyles and expectations satisfy their social and recreational needs. Residents and relatives were confident that they were assisted and enabled to maintain and make choices about how their lives are run. EVIDENCE: The manager identified that they have now employed an individual to concentrate on identifying and providing leisure and social activities to the resident group in the home. The manager was open with regards to the lack of progress made in this area since the last inspection but was confident that progress would be made in the very near future. Residents confirmed the lack of activity provision and the absence of any structured provision of social activity both in and outside the home. It is recommended that the new activities person be assisted to record each individual’s social interests and plan for them appropriately. 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. Those residents spoken to said that they felt they were consulted on how their care was provided by the home. They knew that the home arranged resident meetings to consult them and that they are also provided with a newsletter
Corinthian House DS0000001334.V285678.R01.S.doc Version 5.1 Page 14 providing up to date social news. Residents spoken to were very positive about the care staff and said that they helped them maintain the ability to have a choice. Residents are enabled to take in personal possessions and this was very evident from talking to residents in their bedrooms. Corinthian House DS0000001334.V285678.R01.S.doc Version 5.1 Page 15 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): 18 More structured and recognised training is needed to ensure the resident group are appropriately protected from abuse. EVIDENCE: The home has now trained two members of staff as Adult Protection trainers. They have just recently completed this training and are in the process of identifying a system to ensure all staff receive recognised training in this area. Staff have been provided with a basic knowledge in adult protection by the manager prior to receiving the more structured training. Residents spoken to were confident that they were in safe hands. The home has a robust adult protection policy. A flow chart has been developed as guidance for staff in the event that they need to report an incident of adult abuse. This guidance has been developed in line with the Leeds local adult protection guidelines. It was recommended that the telephone numbers of the relevant organisations be included with this guidance to further assist staff. Corinthian House DS0000001334.V285678.R01.S.doc Version 5.1 Page 16 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): 19,26 Residents expressed that they were happy with the facilities and layout of the home. The home maintains a good standard of cleanliness which has been recognised by a number of relevant stakeholders. EVIDENCE: This is a purpose built home which is accessible, safe and well maintained. There is a programme of routine maintenance. The grounds surrounding the home are attractive and tidy allowing residents access during suitable weather conditions. Those wishing to do so can access the garden areas of the home. Residents said that they felt very comfortable in their surroundings. One resident said,” I know its nothing like my own home but it is the next best thing.” The residents, relatives and visiting professionals spoke positively regarding the cleanliness and appearance of the home. The home is kept clean and free from offensive odours. Residents said the domestic staff work hard to maintain
Corinthian House DS0000001334.V285678.R01.S.doc Version 5.1 Page 17 this standard. There is information displayed in the sluice areas and other areas regarding infection control. Domestic staff have recently undergone training in the Control of Substances Harmful to Health and have also been enrolled onto NVQ level 2 in Housekeeping. Corinthian House DS0000001334.V285678.R01.S.doc Version 5.1 Page 18 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): 27,30. The home ensures that suitable numbers of staff are duty to meet the care needs of the resident group. Staff receive training in a number of areas relevant to the resident need. However, at present all training needs are not provided for. EVIDENCE: Staff training was discussed with the manager. It was agreed that this was an area that needed more input. This was something that she has already begun to audit and is in the process of identifying what training is needed and which staff member needs it. Internal and external training is provided in areas such as first aid, diabetes, strokes, oral care and pressure relief. There is a noticeable absence of specialist training in areas such as Dementia and violent and aggressive behaviour. Although the home is not registered to take residents that have a primary need of dementia, a large proportion of the client group have this illness. The home at present is not able to evidence that the staff group are suitably trained in this area and have the necessary skills and knowledge to provide for residents with this need. The manager agreed with this and gave assurances that this would be reviewed. Corinthian House DS0000001334.V285678.R01.S.doc Version 5.1 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): 31,33,35,36,38 The resident group are now benefiting from a management and staff team that are now committed to identifying areas for improvement. EVIDENCE: The registered manager, deputy manager and the remainder of the staff group have clearly worked hard since the last inspection in an attempt to meet the National Minimum Standards and comply with the regulations. The residents, relatives and visiting professionals to the home, have also identified this during the inspection. Good improvements have been made and there is an obvious commitment to continue to improve the quality of care provided in this home. Evidence was identified to show the home is committed to improving the quality of the service already provided. Resident meetings and staff meeting are taking place. Questionnaires are used to identify resident and relative views of the service. The complaints procedure is well displayed within the
Corinthian House DS0000001334.V285678.R01.S.doc Version 5.1 Page 20 home and complaints are appropriately dealt with. The home has investigated two complaints that were sent to the commission. These were appropriately investigated and the requirements made as a result were complied with. The personal financial records of those service users, which the home deals with, were examined and found to be in good order. A discussion regarding supervision was held with the manager and it was agreed that a more suitable supervision process would be introduced, as the current system did not meet with the standard. The health and safety systems for ensuring the residents were appropriately protected were recorded and up to date. The environment risk assessments in all areas of the home had been completed. The records for checking bed rails, hot water outlets, portable electrical equipment, hoists and wheelchairs were all in order and up to date. There is also a programme in place for ensuring mandatory training is provided to those carers who require it. Corinthian House DS0000001334.V285678.R01.S.doc Version 5.1 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 4 2 x x x 4 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 2 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 3 x 3 2 x 3 Corinthian House DS0000001334.V285678.R01.S.doc Version 5.1 Page 22 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 Standard OP2 Regulation 5 Requirement Each resident must be provided with a Statement of Terms and Conditions or a Contract at the point of moving into the home. (This refers to the absence of terms and conditions provided to Intermediate Care residents.) The registered person must ensure the care plans are drawn up with the involvement of the resident. (The previous timescale of 31/11/05 was not met.) The registered person must ensure that prescribed care is appropriately administered. This relates to pressure area care. (The previous timescale of 31/10/2005 was not met) The registered person must ensure that locks are fitted to residents’ bedroom doors to ensure their privacy and dignity is respected. (The previous timescale of 31/01/06 has not been met.) The registered person must record and provide for the leisure interest of residents. (The previous timescale of 31/10/05
DS0000001334.V285678.R01.S.doc Timescale for action 31/05/06 2 OP7 15 31/05/06 3 OP8 12 31/05/06 4 OP10 12 31/05/06 5 OP12 12 31/05/06 Corinthian House Version 5.1 Page 23 6 OP18 12 7 OP30 18 8 OP36 18 was not met) The registered person must 31/05/06 ensure that all residents are safeguarded against possible abuse. (The previous timescale of 30/09/05 was not met.) The registered person must 31/05/06 ensure that staff are appropriately trained to carry out their role. Specialist training in dementia must be provided to the staff group to ensure they can meet the needs of the residents. Carers must receive formal 31/05/06 supervision at least six times a year. 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 OP9 OP10 OP12 OP28 Good Practice Recommendations It is recommended that the home develop a robust risk assessment to enable residents to self medicate if they so wish. It is recommended that the home invest in suitable clothing protectors for residents when they are eating their meals. Plastic aprons are not appropriate or suitable. The registered person should provide service users with up to date information of about activities and events. The home should ensure that a minimum of 50 of staff are trained to NVQ Level 2 or above. Corinthian House DS0000001334.V285678.R01.S.doc Version 5.1 Page 24 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
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