CARE HOMES FOR OLDER PEOPLE
Deerlands 48 Margetson Road Sheffield South Yorkshire S5 9LS Lead Inspector
Jayne Barnett-Middleton. Unannounced 10th May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Deerlands J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Deerlands Address 48 Margetson Road Sheffield South Yorkshire S5 9LS 0114 2213258 0114 2322138 diane.iwanejko@sheffcare.co.uk Sheffcare Limited 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) Diane Iwanejko PC Care Home Only 40 Category(ies) of OP Old Age (40) registration, with number of places Deerlands J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Three service users between the ages of 55 and 64, inclusive, may reside at the home. Date of last inspection 9th November 2004 Brief Description of the Service: Deerlands Care Home provides care for male and female service users over the age of 65, (three service users may be between the age of 55 and 64). The home caters for 40 service users and a day centre service is attached to the home. The home did not provide intermediate care. Deerlands is situated on Margetson Road with access to local amenities such as shops, library and churches. The home is situated on ground level and there are ramps and handrails provided where necessary. The home has a car park and gardens. Deerlands J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out from 9.00 a.m to 2 p.m. Eleven residents, seven staff, the registered manger and one visiting professional were spoken to. A sample of records was examined and a partial inspection of the building was carried out. Throughout the inspection positive and professional relationships were observed between staff and residents. The inspector wishes to thank the manager, staff and residents for their time and co-operation throughout the inspection process. What the service does well:
The home had a warm, friendly and welcoming atmosphere. Residents were relaxed and happy to talk about the care provided. All residents said that they were satisfied with the care that they received. They described the manager and staff as “good” and “very, very nice”. Residents were observed to be receiving personal care in a manner that respected their privacy and dignity. The daily routines within the home were flexible and promoted resident choice. There was a good programme of leisure and social activities available. Residents were supported to maintain their religious beliefs and the local church visited the home on a monthly basis to provide a service. A good choice of menu was offered and special dietary needs were catered for. The cook consulted with residents on a daily basis to ensure that they were satisfied with the quality and choice of food provided. Residents said that they enjoyed their meals and described the food as “good” and “smashing”. Complaints made by residents and their relatives were listened to and action was taken to deal with complaints promptly. There was an adult protection procedure and all staff had received adult protection training. The home was very clean, tidy and on the whole well maintained, which promoted a comfortable and homely environment. A training and induction programme for staff was in place that met National Training Organisation (NTO) workforce training targets and over 50 of the staff team held a level 2 or 3 National Vocational Qualification in Care. Systems were in place for staff and residents to voice their opinions and to contribute to the development of the service, which included resident meetings, staff forums and service user surveys.
Deerlands J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 Page 6 Compliments and thank you cards were displayed in the entrance of the home, which thanked the staff for their “loving care” and for promoting a very “friendly home”. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Deerlands J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 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 Deerlands J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3, and 5. Prospective residents and their relatives were provided with the information that they needed. Each resident had a written contract/statement of terms and conditions. Residents were not admitted to the home without their needs being assessed. Residents and their relatives were given the opportunity to visit the home prior to their admission. EVIDENCE: A Statement of Purpose and Service Users Guide were available, these provided residents and their relatives with the information that they needed to make an informed choice about living at the home. A previous recommendation to include greater detail about the qualifications of the provider, the minimum level of team leaders available and the experiences of staff had been met. Residents were provided with a written contract at the point of moving into the home, which set out in detail the overall care and services that would be
Deerlands J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 Page 9 provided. A previous requirement to include a £10 service charge for residents to access their personal files was in the process of being carried out. A full needs assessment was carried out for all residents prior to their admission. Residents had been included with the drawing up of these plans. This confirmed that the service was appropriate for the service user, and provided staff with the information to formulate an individual plan of care. Residents said that they had been invited to visit the home prior to their admission, to assess the quality, facilities and suitability of the home. The home does not provide an intermediate care service. Deerlands J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10. Service users individual needs were assessed and their changing needs were reflected in their plan of care. There were no records to evidence that relatives/representative of service users were involved in the care planning process. Service users had good access to health care services, which met their assessed needs. A policy and procedure to ensure that staff adhered to the safe administration of medication was in place. Service users privacy and dignity was respected. EVIDENCE: Two Care plans set out in detail the action that was required by staff to ensure that all aspects of residents care needs were met. The Care plans had been completed with the involvement of the resident, which gave them the opportunity to agree with staff the help that they needed to live as independently as possible. There were no records to evidence that the relatives/representatives of residents were involved in the care planning process or reviews to enable them to contribute to the care that their relative received. Deerlands J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 Page 11 Records of healthcare visits were maintained and these evidenced that other healthcare professionals, e.g. general practitioner, chiropodist and optician, were visiting residents on a regular basis. Nutritional screening was undertaken for service users on admission. Residents said that their healthcare needs were met and described the care that they received as “good”. One resident described in detail the action that staff had taken to provide her with a new walking stick, which enabled her to take regular walks outside the home. One visiting health care professional described the healthcare provided for residents as “very good” and confirmed that the staff had followed the advice that had been given to promote and maintain the residents health. Residents were observed be receiving personal care in a manner that respected their privacy and dignity. There was a policy and procedure to ensure that staff adhered to safe practices regarding medication and the protection of service users. The recording and storage of medication was checked on a sample basis. Medication had been administered appropriately. Staff had received medication training, which promoted the safe administration of medication. Deerlands J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15. The daily routines within the home were flexible and promoted resident choice. There was a good programme of leisure and social activities available. Residents were encouraged to maintain contact with their family, friends and the local community as they wished. A good choice of menu was offered and special dietary needs were catered for. EVIDENCE: The routines within the home were flexible. Residents were observed to be spending their day as they wished. Several residents were spending time in the lounge, whilst others had chosen to spend time in the privacy of their bedroom. One resident said that they enjoyed walking, “it keeps me active”, and that the staff encouraged her to maintain her independence. An activity worker visited the home on a regular basis and a good range of activities was provided residents said that activities such as bingo, singing, games and crafts were available. Regular trips and excursions took place during the summer months and a trip to Chester Zoo was planned. Deerlands J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 Page 13 Residents were supported to maintain their religious beliefs and the local church visited the home on a monthly basis to provide a service. Residents said that their friends and relatives were welcome to visit them at any reasonable time. A good choice of menu was offered and special dietary needs were catered for. The cook consulted with residents on a daily basis to ensure that they were satisfied with the quality and choice of food provided. Residents said that they enjoyed their meals and described the food as “good” and “smashing”. Deerlands J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. The complaints procedure was clear and accessible. Complaints made by residents and their relatives were listened to and action was taken to deal with complaints promptly. There was an adult protection procedure and all staff had received adult protection training. EVIDENCE: The complaints procedure ensured that residents and their relatives were aware of how to make a complaint and who would deal with them. Residents stated that they were satisfied with the care provided. They confirmed that they had no complaints, however they would speak to the manager or staff should they have any concerns regarding any aspect of their care. There was an adult protection policy and procedure that promoted the protection of service users from harm or abuse. A recent adult protection issue had been dealt with promptly and appropriately. A previous requirement to ensure that all staff were up to date in adult protection awareness had been met. The staff confirmed that they had received adult protection training, which enabled them to identify and report any allegations or incidents of abuse to residents. Deerlands J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20,21,24 and 26. The home was clean, comfortable and in the main well maintained. Service users were provided with an environment that was safe, accessible and homely. EVIDENCE: The home was very clean, tidy and in the main the home well maintained, which promoted a comfortable and homely environment. The home was decorated in a comfortable and welcoming manner including homely touches of pictures and silk flowers. Residents had access to three lounges, which were bright and pleasantly decorated. A function room was provided for religious and entertainment activities. The furniture and fittings were clean and of a good quality. Residents said that they liked the home and that they were comfortable. Deerlands J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 Page 16 There were sufficient toilet, washing and bathing facilities, which were close to resident bedrooms and communal areas. A previous requirement to redecorate one bedroom and to replace damaged wardrobe doors had been met. Several bedrooms were checked and all were very clean and attractively decorated. All the rooms had been personalised by the service user with small items of furniture, photographs and mementoes, which encouraged service users to retain their own identity. The carpets in two bedrooms were worn and lifting, which presented a potential tripping hazard. The manager acknowledged that the occupants of the identified bedrooms were wheelchair users and that maintaining the carpets to a good standard was difficult. The manager was advised to look at providing an alternative floor covering that was more practical and maintained a homely environment. Three dining kitchens were provided which were clean and homely. The work surface in one dining kitchen was worn at the edges and joins, allowing the work surface to become non impervious. Deerlands J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28, 29 and 30. Sufficient and experienced staff were provided that met the assessed needs of service users. A training and development programme was in place. Staff received regular training to update their knowledge and competence. A recruitment procedure was in place that promoted the protection of service users. EVIDENCE: A good skill mix of staff was employed at the home to meet the assessed needs of residents. Several Staff spoken to confirmed that they had worked at the home for several years. It was evident that they had a good understanding of their role and that they had formed positive and professional relationships with residents. Two staff that had been recently employed at the home confirmed that they had “settled in very well” and that their colleagues had provided “brilliant” support during their initial weeks of employment. A training and induction programme for staff was in place that met National Training Organisation (NTO) workforce training targets to enable them to meet the assessed and changing needs of service users. Staff confirmed that they had attended various training courses that included food hygiene, adult protection, moving and handling, customer care and first aid. Deerlands J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 Page 18 The manager confirmed that over 50 of the staff team held a level 2 or 3 National Vocational Qualification in Care, which developed the skills and competence of staff, to enable them to meet the changing needs of residents. A thorough recruitment policy and procedure was in place that promoted the protection of residents. Two files checked contained a range of information including two references, declaration of health and qualifications/training and proof of identification. All staff employed had undertaken a Criminal Records Bureau Check at the enhanced level. Deerlands J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,37 and 38. Residents and staff benefited from the ethos, leadership and management approach. The homes policies and procedures promoted the health, safety and welfare of residents and staff. EVIDENCE: The registered manager had many years within the caring profession, which enabled her to contribute to the care of residents and communicate a clear sense of leadership to staff. Staff described the senior team as “approachable” and “very supportive”. There was a relaxed and friendly atmosphere within the home. Residents spoke positively about the care that they received and described the staff as “good” and “very, very nice”.
Deerlands J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 Page 20 Systems were in place for staff and residents to voice their opinions and to contribute to the development of the service, which included resident meetings, staff forums and service user surveys. Compliments and thank you cards were displayed in the entrance of the home, which thanked the staff for their “loving care” and for promoting a very “friendly home”. The records sampled were very well organised, up to date and securely stored. Detailed Records of accidents and injuries were maintained to ensure that residents were provided with the appropriate observation and supervision required. The staff had received regular training, which promoted safe working practices and the health, safety and welfare of service users and their colleagues. Deerlands J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 2 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 x x 2 x 2 STAFFING Standard No Score 27 x 28 3 29 3 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 3 3 3 x x x 3 3 Deerlands J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 Page 22 Yes. Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5 Requirement The £10 charge for service users to access personal files and its purpose must be included in the service users contract/Statement of terms and conditions. (Timescale of 31st April 2005 not met.) Care plans must be completed with the involvement of the service users relative/representative. The carpets in the identified bedrooms must be replaced or an alternative floor covering provided. The work surface in the identified dining kitchen must be replaced. Timescale for action 31st July 2005. 2. OP7 15 1st July 2005. 1st July 2005. 1st July 2005. 3. OP24 13,16 4. OP26 23 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 OP7 Good Practice Recommendations Relatives/Representatives of service users should be invited to care plan reviews at least twice per year.
J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 Page 23 Deerlands Deerlands J55 S2956 Deerlands V218797 10.05.05 UI Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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