CARE HOMES FOR OLDER PEOPLE
Danes Lea 133 Cardigan Road Bridlington East Yorkshire YO15 3LP Lead Inspector
Ros Sanderson Unannounced 17 August 2005 10.00 am
th 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. Danes Lea J53 J04 S19662 Danes Lea V244239 170805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Danes Lea Address 133 Cardigan Road Bridlington East Yorkshire YO15 3LP 01262 672145 01262 672676 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) Humberside Independant Care Association Ltd Miss Leah Anne Hart Private Care Home 29 Category(ies) of OP, Old Age, mixed, 29 registration, with number DE (E) Dementia, mixed, 29 of places Danes Lea J53 J04 S19662 Danes Lea V244239 170805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 22/02/05 Brief Description of the Service: Danes Lea care home is owned and operated by Humberside Independent Care Association Ltd (HICA) which is a not for profit organisation. The home provides personal care and accommodation for up to 29 service users some of whom may have a memory impairment. The home is located on the east coast in the seaside resort of Bridlington. The home is situated in an area that provides easy access to a variety of local shops, pubs and public transport. Danes Lea is a period property adapted for use as a care home. Accommodation is on two floors with access to the upper floor via a passenger lift. Twenty one bedrooms are for single occupation. There are two pleasant lounges and a conservatory for residents to use. Central to the home is a large garden with views over the bowling green and wide unspoilt views across the south beach and sea. Danes Lea J53 J04 S19662 Danes Lea V244239 170805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over six hours. This included preparation time. The inspection process included speaking with residents, their relatives and staff in the home. The records that were looked at included service user care plans, staff records and maintenance and safety records. The registered manager was available throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better:
The manager must make sure that all pre employment checks are in place for staff before they work unsupervised in the home. The recruitment policy is robust but on this occasion a senior member of staff had been left in charge before the CRB check had been received. She did have a POVA first check that would have allowed her to work under supervision. An official notice was left at the home requiring the manager to address this immediately. Danes Lea J53 J04 S19662 Danes Lea V244239 170805 Stage 4.doc Version 1.40 Page 6 The home uses bed rails for a lot of residents and there are no risk assessments in place for these. In addition to this overlay mattresses are in use on some of the beds and the rails in use are not those of additional height to ensure they are safe. The manager must review the use of bedrails and put in place risk assessments where required. The manager was required to look at these issues immediately. The home manages personal finances for residents at Red House and on occasions some residents may have a negative balance. This means that other residents money is used to pay for their requirements until funds are received to bring the account in to credit. The manager must not let this happen and if difficulties are experienced getting resident’s personal allowances then social services should be contacted. The manager must make efforts to assist service users to manage their financial affairs independently when possible and encourage them to have their own bank account. 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. Danes Lea J53 J04 S19662 Danes Lea V244239 170805 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 Danes Lea J53 J04 S19662 Danes Lea V244239 170805 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) 3 (6 is not applicable) Residents and their representatives can feel confident that their assessed needs will be met at Danes Lea. EVIDENCE: Records showed that a pre admission assessment is carried out for all prospective residents and this assessment is completed with the co-operation of the resident or their representative. All parties concerned sign the assessment to indicate agreement and participation in the process. The assessment looks at all areas of care and personal needs for the resident. Some residents are admitted under the Care Management process and the home has copies of the initial assessment and care plan produced by the care manger. A relative confirmed that this process does take place. In the case of admissions where it has not been possible to arrange a pre admission assessment then the assessment is carried out as soon as possible after the admission. Danes Lea J53 J04 S19662 Danes Lea V244239 170805 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Residents have all their needs met in a way that meets individual needs and promotes privacy, dignity and respect. EVIDENCE: Each resident has a clear care plan in place that is based on the initial needs assessment and those needs identified during day-to-day care. The plans are reviewed on a regular basis by the home and annually by the Care Management team where appropriate. There is provision in the plans for residents to sign to agree the plans. Residents have access to primary healthcare professionals and a G.P of their choice; this is recorded in the care plans and was confirmed by a relative of a person resident at the home. The home provides specialist equipment for residents who require it and liaise with other professionals to ensure that residents have access to aids and adaptations in the home to enable them to be as independent as possible.. Since the last inspection the home has arranged for the drug, Temazepam to be stored correctly. The systems used for the storage, handling and administration of medication ensure residents safety at all times. Staff dealing
Danes Lea J53 J04 S19662 Danes Lea V244239 170805 Stage 4.doc Version 1.40 Page 10 with medication have all received training. No resident looks after their own medication at this time but should they wish to the home could provide lockable facilities in rooms for safe storage. Residents expressing a wish to look after their own medicines would have a risk assessment completed and the permission of the G.P. would be sought. Residents spoken with confirmed that they are satisfied with the care they receive. Comments included, ‘I’m looked after very well here and couldn’t ask for a better place.’ ‘The food is good’ A relative spoken with said, ‘Everything is brilliant,……….is very happy here, the care is superb and I am kept fully informed’. Residents confirmed that their privacy is respected. A relative said that carers always knock on bedroom doors before entering. Staff were observed during the inspection interacting well with residents. The residents were spoken with respectfully and given the time and space to express their wishes and hold a conversation. Call bells were seen to be answered promptly. Danes Lea J53 J04 S19662 Danes Lea V244239 170805 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14 &15 Residents are encouraged to exercise choice in their day-to-day lives. Residents are provided with a varied diet that is wholesome, healthy and nutritious. EVIDENCE: The home holds regular residents meetings and encourages residents to have a say in the day-to-day running of the home, where possible. Quality circle meetings are also held and relatives are encouraged to attend. All relatives are invited to periodic reviews of the individual care plans. As part of the homes quality assurance questionnaires are sent out to residents and their relatives and their views taken into account. There is information within the home of advocacy services available for residents. Residents are encouraged to bring into the home personal possessions to make their rooms feel like home. None of the residents at Danes Lea handle their own financial affairs. The kitchen is well equipped and staffed by two chefs. The chef on duty was knowledgeable about resident’s dietary needs. Food and drink is available at all times and the menus showed a healthy and varied diet is on offer. Alternatives to the menu are available. The food served was well presented and looked appetising. Those residents requiring assistance were given time and helped in a sensitive and discreet way.
Danes Lea J53 J04 S19662 Danes Lea V244239 170805 Stage 4.doc Version 1.40 Page 12 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 Residents and their relatives are listened to and policies in place ensure they are safeguarded and protected. EVIDENCE: The home has a complaints procedure that is available to all residents and their relatives. Relatives confirmed that they were aware of the complaints procedure and who to complain to if they needed. Comments included, ‘I know who to approach if I have a complaint and what to expect but I have never had to make a formal complaint before as a quiet word is usually enough’. The complaints book showed there had been one complaint since the last inspection and this had been dealt with appropriately and within agreed timescales and the complainant satisfied with the outcome. Procedures are in place for responding to allegations of abuse within the home. The policy the home has adopted is in line with the Local Multi Agency Policy and ‘No Secrets’ report. The organisation arranges Protection of Vulnerable Adults training as part of staff’s induction and updates as required. Staff also receive training specific to the client group they care for including Dementia Care and dealing with Challenging Behaviour. Danes Lea J53 J04 S19662 Danes Lea V244239 170805 Stage 4.doc Version 1.40 Page 13 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) 19&26 Residents live in a clean, hygienic and well maintained home. EVIDENCE: The home is easily accessible for all residents and is well maintained so that residents live in pleasant and comfortable surroundings. There is an ongoing programme of renewal and re decoration. The home has an on site laundry with a dedicated laundry person employed. All the laundry equipment meets the specified standards and the laundry is clean and well ventilated. There is evidence around the home of PPE and hand washes for the staff to use. One member of staff said, ‘We have all the equipment we need to do our job and anything else we need all we have to do is ask’. Staff confirmed that they receive the relevant health and safety training. Danes Lea J53 J04 S19662 Danes Lea V244239 170805 Stage 4.doc Version 1.40 Page 14 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) 27,29,30 Residents are cared for by sufficient numbers of staff that are well trained. To ensure residents are safe the manager needs to ensure correct procedures are followed before starting new staff. EVIDENCE: The staff rotas show that there are adequate numbers of staff on duty. At times agency staff are employed and when this happens the manager makes sure they are familiar with the health and safety procedures within the home and receive an induction that covers the objectives of the service and residents needs. All new staff receive a weeks induction at the organisations headquarters and until this is completed staff work under supervision. Staff receive regular supervision on a six to eight weekly basis. Supervision records show that learning and development needs are addressed and training needs identified at these meetings. The organisation encourages staff to undertake NVQ training and many staff have already achieved this qualification. All staff undertake mandatory training and since the last inspection some staff have undergone further training in response to a requirement made regarding moving and handling. Moving and handling practices were observed and only safe systems of work were used. The home has a robust recruitment policy in place. All staff complete an application form, two written references are taken up and the necessary checks are in place. However it was apparent that a senior member of staff had been employed before a Criminal Record Bureau check had been received. This member of staff had a clear POVA check in place but was working
Danes Lea J53 J04 S19662 Danes Lea V244239 170805 Stage 4.doc Version 1.40 Page 15 unsupervised in charge of the home. The manager was required to immediately ensure that this member of staff did not work unsupervised until a satisfactory CRB check had been received. Danes Lea J53 J04 S19662 Danes Lea V244239 170805 Stage 4.doc Version 1.40 Page 16 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) 33,35,38 The home is managed in a way that fosters openness and respect and ensures residents, relatives and staff feel valued. and their safety and welfare are protected. To ensure residents are safe and their interests and welfare safeguarded the manager must meet the requirements made in this report. EVIDENCE: The home has an effective quality assurance and monitoring system in place and the views of all who use the service are sought. The results are used to develop the annual service review for the home that is available for all interested parties. The home holds personal monies for a number of residents. The monies are held in a bank account under the umbrella of ‘Danes Lea Residents Account’. Computer records in the home are able to show how much each resident has in the account. Cash held in the home for residents is held collectively in a single
Danes Lea J53 J04 S19662 Danes Lea V244239 170805 Stage 4.doc Version 1.40 Page 17 cash box. The home can produce individual accounts for each service user. However, in some circumstances residents accounts may fall into a debit balance that effectively means other residents are subsidising this account. The homes administrator had, in the past, prevented accounts going into debit by using the homes ‘welfare fund’ as an interim measure until further funds were received from the resident’s representatives. This procedure was not approved by the organisation as difficulties may have arisen in recouping any money. The situation is the same for residents and the manager must ensure that resident’s financial interests are safeguarded and that this practice stops. If difficulties are encountered obtaining personal allowances for residents then social services should be involved. The manager must make efforts to assist service users to manage their financial affairs independently when possible and encourage them to have their own bank account. There are a large number of bed rails in use throughout the home. Risk assessments were not in place and consents had not been obtained. In addition to this overlay mattresses were in place and the bed rails were not of additional height to compensate for this. A notice was left with the manager requiring her to review the use of bed rails and ensure that when they are used they are used safely. Danes Lea J53 J04 S19662 Danes Lea V244239 170805 Stage 4.doc Version 1.40 Page 18 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 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 1 x x 1 Danes Lea J53 J04 S19662 Danes Lea V244239 170805 Stage 4.doc Version 1.40 Page 19 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 29 Regulation 19(4(b)(i) sch 2 para7 13(6) Requirement Staff should not work in the home unsupervised until a satisfactory CRB check has been received The manager must ensure that where the home looks after residents monies none of the accounts are allowed to fall into a debit balance. If problems arise about residents personal allowances the manager should refer to social services. The manager must: Review the use of bed rails for residents in the home. Risk assessments must be in place for all residents that require the use of bed rails Ensure that when in use the bed rails are used safely Timescale for action Immediate 2. 35 On receipt of this report and continued thereafter. 3. 38 13(4( c)) Immediate Danes Lea J53 J04 S19662 Danes Lea V244239 170805 Stage 4.doc Version 1.40 Page 20 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 Good Practice Recommendations Danes Lea J53 J04 S19662 Danes Lea V244239 170805 Stage 4.doc Version 1.40 Page 21 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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