CARE HOMES FOR OLDER PEOPLE
Cornerways Residential Home 15 Leadhall Crescent Harrogate North Yorkshire HG2 9NG Lead Inspector
Kate Shackleton Key Unannounced Inspection 20th June 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 Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 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. Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Cornerways Residential Home Address 15 Leadhall Crescent Harrogate North Yorkshire HG2 9NG 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) 01423 871017 01423 871017 Amocura Limited Mrs Valerie Healey Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th March 2006 Brief Description of the Service: Cornerways is run by Amocura Limited and is registered to provide care for 24 older people aged 65 years and above who have no specialist care needs. The home is a converted and extended two-storey building set in its own grounds. It is in a quiet residential area on the outskirts of Harrogate within walking distance of local shops and public transport links. The upper floor is accessible via passenger lift. The Service User Guide, which contains information about the home, is given to prospective service users. The Commission for Social Care Inspection report is given out with the guide. At the time of this visit weekly fees ranged from £346:00 to £445:00. There are no additional charges made by the home. Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The accumulated evidence used in this report has included: • A review of the information held on the homes file since its last inspection. • Information submitted by the registered provider in the Pre Inspection Questionnaire. • An unannounced visit to the home, which lasted eight hours and included a tour of the premises, talking to service users, care staff and management. Examining some records and observing staff working with service users. What the service does well: What has improved since the last inspection?
There has been some redecoration and refurbishment to three bedrooms, the kitchen and landing. This ensures that the environment provided for service users is kept to a good standard. Door locks that are unable to be deadlocked have been fitted to some bedrooms, toilets and bathrooms and the fitting of a fire extinguisher has been
Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 Page 6 made safe. These were requirements made at the last inspection. The completion of this work promotes the safety of service users. What they could do better:
Since the last inspection the home has not been managed in a way that ensures that the needs of service users are properly identified and planned for. Admissions to the home must only take place when a full needs assessment has been undertaken and the home can confirm that they can meet the needs of the individual through the service they deliver. Management should consider discussing the application with other staff where all information is shared, views, opinions, and comments are listened to and fully debated, before agreement is given for the admission. This ensures the best possible results for people being admitted to the home. Each service user must have a care plan that has been agreed with them. It should be written in plain English, easy to understand and consider all areas of the individual’s life including health, personal and social care needs. The plan must also include a risk assessment. Areas should be identified where staff are willing to support residents to take some risks in order for them to live interesting and fulfilling lives. Staff need to be provided with the skills and ability to support and encourage service users to be involved in the ongoing development of their plan and make the process interesting and worthwhile. The re-introduction of the key worker system would help this process allowing staff to build up special relationships with service users and work on a one to one basis with them. Sufficient staff resources must be made available to allow for activities and stimulation. The key worker system would enable closer service user staff relationships where likes dislikes and needs are shared, Key workers can then plan the activities that service users enjoy. The home needs to develop a system for displaying information and bringing attention about community events. When service users have particular interests every effort should be made to help the service user maintain their interest and keep up any community involvement. Equipment should not be stored in service users sitting rooms. It is not conducive with an environment where service users and visitors want to sit and relax and could have safety implications. Improvements need to be made in getting staff to complete NVQ training so that a minimum of 50 of care staff have an NVQ level 2 or equivalent. Higher numbers of care staff achieving NVQ level 2 or above means more staff on each shift have received the training relevant to the work that they do. This ensures that service users receive a service from a better informed staff team whose practice is up to date. Management and staff need to be aware of equality and diversity issues to ensure that staff are able to translate understanding into positive results for service users in the areas of race, ethnicity, age, sexuality, gender, disability and belief.
Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 Page 7 Management must introduce more efficient systems to monitor staff adherence to policies and procedures during their practice and that staff receive feedback on their work. Staff should receive a minimum of six supervision sessions in a year and an annual appraisal. This ensures that the work of care staff is consistently monitored in the best interests of service users. The Registered provider and manager needs to look at imaginative ways that service users, staff and any other interested parties can be involved in the running of the home. This promotes an open and inclusive management style and allows service users and staff some ownership about the service delivered. 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. Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 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 Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 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): 3. Standard 6 does not apply to this service. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. The lack of a personalised needs assessment means that the diverse needs of service users are not identified and planned for before admission. EVIDENCE: Case tracking confirmed poor practice. Two of the three service user files examined showed incomplete assessments prior to admission. The information gathered did not give a true reflection of all of the needs of the prospective service users. One of the service users whose care was tracked had visited the home before deciding to move there. Another service user spoken to who had recently moved in was familiar with the home prior to admission through visiting a friend who lives there. She was very happy with the arrangements stating that “Anything you ask for, if they can get it they will.” Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 Page 10 Service users spoken to were unable to recall any information provided to them prior to admission, which would have help, them make an informed decision about moving in. The deputy manager said that all prospective service users/enquirers are given a copy of the homes Service User Guide. Four care staff were spoken to and were able to describe the admission procedure and the importance of making sure that the new service users felt welcome. They confirmed that they are given verbal information relating to the personal care support needed when a new service user is admitted. Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The lack of a detailed and comprehensive care plan means that a service tailored to meet the diverse needs of service users cannot be provided. EVIDENCE: Case tracking confirmed poor practice. Care plans were not completed properly. The diverse needs of individuals were not identified or planned for. The planning that was in place referred mostly to the physical needs of service users. The social care needs were not identified. Service users or an advocate have not sign the plans suggesting that they have not been involved. A monthly review of the plan takes place ensuring that any changes to service users physical needs are identified and acted upon. Risk assessments and nutritional assessments are completed. Service users spoken to were unaware that they have a care plan and don’t recall being involved in its development. Discussions with staff found that they are aware of the plan but are not involved in the development of it with the service user. Staff are however meeting some of the needs of service users despite a lack of clear plans and guidance. Service users looked clean and well
Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 Page 12 cared for. Staff complete a daily record for each service use and inform management of any changes to service users needs. Staff were observed providing support in a kind and helpful manner. They were able to give examples of best practice relating to the promotion of respect for the privacy and dignity of service users. Service users are registered with a General Practitioner and are able to access the primary health care team. Medicines are stored and administered safely. No one takes care of their own tablets and there was no evidence to suggest that service users are given this option subject to a proper risk assessment. One staff member spoken to was surprised to hear that service users should be consulted or in control of this aspect of their health care. Service users are at risk of not receiving a service that is tailored to meet all of their individual needs Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 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): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. A limited range of activities within the home and community mean that service users do not have a range of opportunities to participate in stimulating and motivating activities. The lack of an interesting and stimulating lifestyle has the potential to place some service users at risk of ill being. Meals and meal times are relaxed and an enjoyable experience for service users. EVIDENCE: Case tracking confirmed that service users interests are not recorded and they are not provided with the opportunities for stimulation through leisure and recreational activities in and outside the home. Service users spoken to were not aware of any programme of activities that is available other than playing bingo. The activities programme seen was poor. It amounts to a member of staff once a week involved in chatting individually with some service users and some in house games. The needs of people with cognitive impairment, sensory loss and physical disability are not considered. Throughout the day service users were seen sitting in their bedrooms, in the lounges and the entrance hall. The television was on in one lounge. Staff were observed interacting with service users only when they were offering support to complete a task. At the last inspection of the home the manager was asked to investigate further some service users dissatisfaction with the variety and level of activities. The
Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 Page 14 lack of a stimulating environment has the potential to impede service users well being. Service users spoken to said that they can see visitors in private and that they are made welcome. Visitors were seen in the home. A local voluntary group visits the home, bringing in dogs for the service users to pat. A local vicar visits monthly to give communion. Service users confirmed that they are able to make some choices in their daily life and staff spoken to were able to give examples of how they support service users to exercise some control. Menus are varied and nutritionally balanced. There is a choice of food at each mealtime and special diets are catered for Service users mostly eat in the dining room but some have their meal in their bedroom. Staff were observed offering service users a choice of meal. Dining room tables were set properly with appropriate cutlery and condiments. Staff served meals from a tray with discreet support being provided when needed. Mealtimes were relaxed and unhurried allowing service users as much time as they needed to complete their meal. Service users confirmed that they were happy with the quality and quantity of food provided. There are no facilities for service users to make their own drinks or snacks. Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 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): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Service users feel able to air their concerns without any fear of repercussions. EVIDENCE: A complaints procedure is included in the Service User Guide. Service users spoken to said that if they were unhappy with any aspect of the service they would either talk to the manager themselves or ask a relative to. One service user said that the manager “has been very kind since I came in.” Staff spoken to were able to give examples of the types of complaints that sometimes arise and how they are dealt with. Staff knew how to respond to any suspicion or allegation of abuse. Abuse awareness training is provided. Due to some recent breaches of confidentiality coming to light a staff meeting was arranged to reinforce the homes policy and procedure on confidentiality and inform staff about how best practice in this area of their work must be achieved. Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Service users live in a clean, safe and comfortable home. EVIDENCE: The home was clean and fresh. The majority of bedrooms are single with two doubles. One room has an en suite facility. Service users felt that the cleanliness of the home was good. The home employs domestic staff to do the cleaning. Service users are able to furnish their rooms with personal possessions. Communal areas are comfortably furnished and decorated to a good standard. One lounge was storing a large hoist and “sit-on” weighing scales. The storage of equipment in this way is not conducive with an environment where service users are expected to sit and relax. Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 Page 17 Aids and adaptations are provided and regularly serviced. There is a choice of assisted and unassisted bathing facilities and there are a number of toilets strategically placed around the home. Bedrooms have commodes. Staff spoken to were aware of the homes policy on infection control. The home employs a handyman who is responsible for routine maintenance and the monitoring of some health and safety aspects of the premises. Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 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): 27,28,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users benefit from a properly vetted and appropriately trained staff group. EVIDENCE: Staff were observed responding quickly and appropriately to requests from service users and spent time talking to them. Service users spoken to said that staff were always available to provide appropriate support. One service user spoken to said staff “were all very kind.” The rota showed that there is enough care staff on each shift taking into account times of peak activity. Staff spoken to felt that in general they had enough time to deliver a good service. However recent staff sickness has meant that care staff have had to do cleaning jobs, which they feel, has prevented them from spending time with service users. Senior management resolved this situation immediately by arranging for additional cleaning staff to cover daily shifts for the remainder of the week. The three staff files examined showed a satisfactory recruitment process, which endeavours to make sure that only suitable people are employed. There is an induction programme that ensures new staff members are given the right information to be able to do their jobs well. Staff spoken to said that the on going training programme is good providing them with the skills and knowledge to meet service users needs. The training programme includes all the mandatory training needed to meet service users basic needs such as
Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 Page 19 lifting and handling and health and safety. Specialist training provided includes dementia care, nutrition, continence and abuse awareness. Staff said that they are able to identify their training needs in supervision sessions with the manager. 25 of the care staff have achieved National Vocational Qualification level 2. In order to ensure a workforce whose practice is up to date and in line with current best practice this percentage needs to improve to 50 . This has been recommended in the last two inspection reports. Agency staff are rarely used. Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 Page 20 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): 31,32,33,34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The lack of consistent good management support to staff and the minimal involvement of service users in the way the home is run has the potential to jeopardize the quality of service delivered. EVIDENCE: The manger is qualified and experienced. She is accountable to a senior manger within the company. At the time of this visit the manager was not available. The lack of clear guidance to staff about how to deliver a specific service to meet each individuals needs and an absence of any real strategies that enables staff, service users or other interested parties to affect the way in which the home is run has the potential to adversely affect service delivery.
Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 Page 21 Staff meetings are few and there is a poor record of staff supervision and appraisal. Service users spoken to were not aware that residents meetings are arranged where ideas for improvements can be put forward. They were unable to give any examples of their involvement in the running of the home. The Senior manager visits at least monthly and completes a quality audit. This includes discussions with service users to get their views about the service provided. Service users and relatives are surveyed annually, the findings are analysed and informs the development plan for the home. Systems are in place to ensure the safekeeping of any monies held on behalf of service users. The home has a health and safety policy. Regular checks are made and staff are trained in health and safety matters. Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 Page 22 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 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 1 3 X 3 1 X 3 Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 OP3 Regulation 14 Requirement Timescale for action 20/07/06 2 OP7 15 3 OP12 16 Accommodation must not be provided to service users until their needs have been assessed. The assessment must be in sufficient detail to enable care staff to meet the service users needs, be kept under review and having regard to any change of circumstances be revised as necessary. Unless it is impracticable to carry 31/08/06 out such consultation, the registered manager must after consultation with the service user, or their representative prepare a written plan. The plan must be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet service users health and welfare needs. Plans must be kept under review. Plans must be made available to service users and be signed by them or their representative. A planned varied programme of 31/08/06 activities must be developed to meet the needs, capabilities and wishes of all service users.
DS0000007963.V300773.R01.S.doc Version 5.2 Cornerways Residential Home Page 24 4 OP32 10(1) 12 The registered provider and manager must make arrangements to enable service users and staff and other interested parties to be more involved in the running of the home. Care staff must receive formal supervision at least six times a year. 31/08/06 5 OP36 18(2) 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP19 OP27 Good Practice Recommendations Aids and equipment should not be stored in communal sitting areas. 50 of care staff should be qualified to NVQ2 in care. Cornerways Residential Home DS0000007963.V300773.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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