CARE HOMES FOR OLDER PEOPLE
Culrose Norwich Road Dickleburgh Diss Norfolk IP21 4NS Lead Inspector
Mrs Susan Golphin 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 Culrose DS0000059073.V301244.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. Culrose DS0000059073.V301244.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Culrose Address Norwich Road Dickleburgh Diss Norfolk IP21 4NS 01379741369 01379740186 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) Jean Whitten Care Ltd Miss Leanne Prest Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Culrose DS0000059073.V301244.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Twenty (20) Older People, not falling into any other category, may be accommodated. 23rd November 2005 Date of last inspection Brief Description of the Service: Culrose is a converted and extended detached property in the village of Dickleburgh. The home can accommodate up to twenty older people in sixteen single and two double bedrooms on the ground and first floors. Three single bedrooms have en suite facilities. The home has a dining room and two lounges, one of which can be used for service users who wish to smoke. There is car parking to the front and gardens to the rear of the property. The range of monthly fees is £281-to -£338 with £20-30 top up costs for accommodation with en-suite facilities. Culrose DS0000059073.V301244.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups, which assess how well a provider delivers the service to people. The key inspection has been carried out by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This report gives a brief overview of the service and the current judgments for each outcome group. What the service does well:
Culrose is a small home and residents and staff have a positive and open relationship, and appear relaxed and comfortable with each other. There are seventeen residents accommodated of which four are very frail and being cared for in bed. They have been provided with appropriate specialist beds and mattresses to ensure good skin care and prevent pressure areas developing. Clear records are being maintained to monitor each resident’s nutritional intake and fluids. Resident’s health care needs are well met, and their privacy and dignity is respected. One resident said that she may no longer have a house of her own but she still has a home – at Culrose. Another said that from the first day in the home she felt safe and comfortable and did not want to return to her own bungalow where she had experienced isolation and loneliness. Despite the sudden absence of one member of staff due to illness, the remainder were observed appropriately meeting the resident’s needs throughout the day. During the discussions resident’s said that the staff are kind and thoughtful and gave examples of personal care and individual kindnesses shown to them. The registered providers have a long-term plan for upgrading and extending the premises. Two of the double rooms are now used for single occupancy and there is a small extension planned to maintain the registered numbers (20). Culrose DS0000059073.V301244.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
Continue with the long-term programme of improvement to the premises including redecoration and carpeting in the hall and corridors and stairs on the ground and first floor levels. It is acknowledged that redecoration and upgrade of the communal areas will take place once the extension at the rear of the home is completed. At the last inspection carried out in November 2005 a requirement was made to fit pre set valves to control the hot water temperature in residents rooms. The timescale set was 31 March 2006 this work is still outstanding and needs to be completed immediately, to ensure hot water temperatures are governed to safe levels in all residents rooms During the course of the inspection it was noted that the heating / hot water system was on and could not be turned off at some of the radiator points. The
Culrose DS0000059073.V301244.R01.S.doc Version 5.2 Page 7 towel rail in the first floor bathroom, which is currently not used by residents but can be accessed by them was found to be very hot to the touch and could not be turned off or down. Priority should be given to reviewing the way in which the central heating and hot water systems function throughout the home and work undertaken immediately to ensure that all areas accessed by residents are safe from any risk of scalding or burning. The initial proposal to relocate the storage facilities for medication, laundry and staff cloak room should be implemented as a matter of some urgency to improve the overall tidiness and maintenance of the home and provide improved space for the appropriate storage of pre packed medicines and the returns. Work on the main bathroom on the ground floor has yet to be completed. The radiators throughout the home have been covered with undressed timber and need to be cleaned down and varnished or painted to remove staining and dirty marks and improve the overall standard and protect the wood. Some of the exposed wiring which is being accessed through the ceiling trap doors into the roof space needs attention and should be fitted through appropriate conduits so that the ceiling access trap doors are close fitting. The risk assessments for residents which forms part of the assessment of need and plan of care need to be reviewed and extended to provide a more individual assessment of personal risk which covers all aspects of day to day activity and care. Resident’s files need to be reviewed and updated with attention given to securing loose-leaf documentation and record sheets so that information can be easily accessed and are in good order. 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. Culrose DS0000059073.V301244.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 Culrose DS0000059073.V301244.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): 3,6 The quality outcome for this group of standards is adequate. The home has a basic process in place for assessing care needs of prospective clients. The home can accommodate and support people in need of respite or shortterm care. There is no separate or specialist intermediate care facilities provided on site. EVIDENCE: Prospective residents to the home are assessed either by the commissioning services or by the senior staff of the home. The initial assessments are completed prior to admission and form the basis for the agreed plan of care. Where possible residents and their representatives are involved in the process. Residents spoken to could not recall being involved in the assessment process or reviews. (See recommendation) The home can accommodate residents in need of short-term care or respite care. On resident said that she had stayed at the home for short periods of time and it had helped her to come to terms with accepting permanent care arrangements but also had enabled her to remain in her own home a little
Culrose DS0000059073.V301244.R01.S.doc Version 5.2 Page 10 longer. Residents are encouraged to maintain their independence and selfdetermination whilst receiving respite care support although there is no separate intermediate or rehabilitation facility at the home. Culrose DS0000059073.V301244.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 The quality outcome for this group of standards is good. Resident’s health, and care needs are set out in an individual plan of care. Resident’s needs are fully met. The policies and procedures for management of medicines are in place. Resident’s rights are respected and upheld by staff. Residents are assured that staff can care for residents reaching the end of their lives with dignity. EVIDENCE: A small sample of resident’s files were seen on the day with evidence that assessments of need have been completed and regular reviews are in place. There are good records relating to nutrition and fluid intake for those residents who are cared for in bed. Risk assessments could be more detailed if they are to reflect real elements of risk especially for those residents who are active and independent. Residents and their representatives should be encouraged to be involved in the planning process and any periodic reviews. The care plan files would benefit from being
Culrose DS0000059073.V301244.R01.S.doc Version 5.2 Page 12 reviewed and refreshed to ensure that only current information is in place and is secure. (See recommendation). Residents spoke with warmth and affection about the care they receive and about the management and staff residents confirmed that staff are respectful and considerate towards them. Two of the key staff were observed offering a good standard of care and support to four very frail residents with high dependency needs. Good records relating to fluid and nutritional intake are maintained. There are no incidences of pressure sores or poor tissue viability. One resident recently admitted is receiving treatment from the district nursing services for pressures sores developed prior to admission. Comment cards received from relatives and visitors expressed satisfaction with the overall service provided. Changes have been made to the way in which medication is stored. A small fridge and controlled drug facility have been installed. The space used for the storage of medication is confined and there are plans to improve this facility as part of upgrade programme. (See recommendation) Culrose DS0000059073.V301244.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): 12,13,14,15 The quality outcome for this group of standards is good. Resident’s lifestyle in the home matches their expectations and preferences and satisfies their cultural, social, religious and recreational interests and needs. Resident’s maintain contact with their family and friends as they wish. Residents are helped to exercise choice and control in their lives. Residents receive a wholesome, and balanced diet in pleasant surroundings. EVIDENCE: Residents said that they are, in the main content with their way of life and can make choices about what they like to do each day. There is a great interest in the garden and the local birds with facilities for feeding and attracting them to the garden. Activities are organised on a regular basis and a notice is displayed in the hall. On the day of the inspection there was a session of musical movement taking place. Family and friends can visit at any time and can be seen in private as residents wish. There is a four weekly menu offering a range of meals and choices. Residents confirmed that the meals are plentiful and tasty, and sometimes ‘too much’. A
Culrose DS0000059073.V301244.R01.S.doc Version 5.2 Page 14 small number of residents have softened or liquidised meals and the management and cook have been asked to review their current practice so that each item of food is liquidised separately and the meal maintains its identity and colour. (See recommendation). Visiting the kitchen the cook demonstrated a good knowledge and understanding of the needs of residents. The kitchen is clean and well maintained. The cook is provided with information about the dietary needs and residents food choices and likes and dislikes. The daily menu is displayed on a nobo board in the dining area. The dining room is attractive, although some residents choose to eat in their rooms. Culrose DS0000059073.V301244.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): 16,18 The quality outcome for this group of standards is good. Resident’s complaints are listened to, and acted upon appropriately. There are appropriate policies and procedures in place to ensure residents are protected from abuse. EVIDENCE: Residents confirmed that they are aware of the complaints process know who they would contact or talk to if they had any problems. The comment cards received stated that three complaints had been made by relatives but the management are not aware of any formal complaint being made. The management are to canvas the relatives and visitors through the newsletter to clarify the situation and establish the level or degree of concern raised. (See recommendation) Staff records record that staff receive training in the protection of vulnerable adults and CRB checks carried out. Culrose DS0000059073.V301244.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): 19.26 The quality outcome for this group of standards is adequate. The environmental standards for the home are being improved. Safety aspects for the central heating and hot water system need to be applied. The home is generally clean and well maintained. EVIDENCE: Residents rooms and communal sitting and dining rooms are well maintained and in good order. Other communal areas need upgrading and are part of the overall refurbishment of the home, which will take place when the work on the planned extension begins. A small number of resident’s rooms were seen and reflected individual choice and taste. Work on the central heating system and the hot water controls have not been completed within the requirement timescale set at the last inspection. The temperature control of the heated towel rail in the bathroom on the first floor also needs to be adjusted to a safe level. (See requirement).
Culrose DS0000059073.V301244.R01.S.doc Version 5.2 Page 17 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): 27,28,29,30 The quality outcome for this group of standards is good. Resident’s needs are met by staff with a range of skills and knowledge in the care of older people. The home promotes good recruitment and selection processes. Staff training opportunities including NVQ training is promoted. EVIDENCE: The staff rota and staff records reflect a small but efficient and effective staff team. Six staff hold NVQ 2,3 qualifications and mandatory training is in place. Recent sudden absences by staff through illness and one resignation has created a temporary shortfall on a day-to-day basis. The manager can usually access a small bank of relief staff in an emergency. There are no domestic staff on duty at week ends which means that from time to time care staff are distracted from care tasks to domestic duties. Given the frailty and care needs of some of the resident’s, a review of the staff structure to include domestic input to the home everyday would ensure that care staff do not have to undertake domestic /laundry responsibilities. (See recommendation). Culrose DS0000059073.V301244.R01.S.doc Version 5.2 Page 18 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): 31,33,35,38 The quality outcome for this group of standards is adequate. The manager of the home is appropriately trained and experienced in the care of older people. Resident’s best interests are central to the planning and management of the home. There are clear procedures in place for the management and safekeeping of resident’s monies. Improved safeguards to promote the safety and welfare of residents should be implemented. Culrose DS0000059073.V301244.R01.S.doc Version 5.2 Page 19 EVIDENCE: The manager of the home has recently achieved Registered Managers Award. The management hold and manage small sums of monies on behalf of residents. A random sample of records and cash held were checked and found to be in good order. However one of the running balances had been totalled incorrectly and this was amended at the time. Two signatures should always be obtained when any expenditure on behalf of a resident is undertaken. Records relating to safe practices in the home, risk assessments for fire safety and protection and general maintenance are in place. Records for moving and handling, basic food hygiene, fire safety, and first aid training for staff are all in place. At the previous inspection a requirement was made to install pre set valves to control hot water temperatures in resident’s rooms this work has not yet been completed (see requirement) In the absence of the manager the inspector was not able to determine whether the views of the residents and their relatives and visiting healthcare professionals are being sought as part of the homes’ quality assurance process. It was agreed that the manager would advise the CSCI of their current process and submit the outcome of any survey of the service carried out this year. (See requirement) Culrose DS0000059073.V301244.R01.S.doc Version 5.2 Page 20 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 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 X 2 X 3 X 3 2 Culrose DS0000059073.V301244.R01.S.doc Version 5.2 Page 21 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 Standard OP21 Regulation 4(a) Requirement Preset valves to control hot water temperatures in residents’ rooms must be installed including the temperature control on the heated towel rail (repeat requirement). Evidence must be produced to show that residents and their relatives are consulted about their views of life at the care home (repeat requirement). Timescale for action 30/07/06 2 OP33 24 (1) 30/09/06 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. Refer to Standard OP3 Good Practice Recommendations It is recommended that the individual risk assessment process for residents is reviewed to accurately assess all the elements of risk for each person and the impact on their day to day lifestyle. It is recommended that the resident’s care plans are reviewed and refreshed to ensure all the documentation is current in good order and secure.
DS0000059073.V301244.R01.S.doc Version 5.2 Page 22 2. OP7 Culrose 3. 4. OP15 OP16 5 6 OP19 OP19 It is recommended that foods that need to be liquidised or softened for special diets should be should be liquidised separately to maintain colour and flavours. It is recommended that the management survey residents their relatives and staff about the nature and status of complaints to ensure that any issue of concern is recorded and any action noted. It is recommended that the registered providers review the central heating system to ensure that radiators can be controlled individually. It is recommended that the registered providers continue with their plan to those areas of the home in need of redecoration and refurbishment as part of the overall programme of improvement. Culrose DS0000059073.V301244.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Culrose DS0000059073.V301244.R01.S.doc Version 5.2 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
