CARE HOMES FOR OLDER PEOPLE
Epworth Care Home Front Street Tanfield Lea Stanley County Durham DH9 9LX Lead Inspector
Gavin Purdon Announced 18 July 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. Epworth Care Home B54 S63231 Epworth V228319 180705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Epworth Care Home Address Front Street Tanfield Lea Stanley County Durham DH9 9lx 01207 7393777 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) x9 Services Limited Mrs P Hardy CRH Care home only 31 Category(ies) of OP Old age, not falling within any other category registration, with number of places Epworth Care Home B54 S63231 Epworth V228319 180705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: none Date of last inspection 30 November 2004 Brief Description of the Service: Epworth Care Home is an establishment for 31 older people in need of residential care, who do not need nursing care. It is situated in the Derwentside District of North West County Durham, at Tanfield Lea, one of the villages near the town of Stanley. There is a shop and other local village amenities close by. Accommodation is on 2 floors, connected by stairs and a passenger shaft lift. Bedrooms are generously sized, the majority having en suite toilets. Outdoor space is very limited at this home, although there is a grassed area and woodland nearby. Since the last inspection, the acting manager, Mrs Pauline Hardy, has been approved as registered manager, and the ownership of the home has passed to a private sector company, X9 Services Limited. Epworth Care Home B54 S63231 Epworth V228319 180705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The overview of the inspection is that the home has a sound approach to identifying residents’ needs and plans to meet these in a way that recognizes and respects the fact that each resident is different. Epworth Care Home takes considerable pride in its being a local service with a friendly approach. The home values good relationships and good communication, between staff, residents, relatives, and local professionals. Importantly, good verbal communication in the home is backed up by good recording, and the care provided is based on written plans as well as staff’s own personal knowledge of residents. Generally, residents, staff, management and residents’ relatives thought the home offered a good service, and that, if anything, that service was getting better. The level of satisfaction expressed and the view that the home was improving shows that Epworth Care Home works hard to protect residents and promote their individuality, and is interested in developing its professional practice. This inspection was announced. It was conducted by 1 inspector, and took 6 hours to complete. The inspector looked at how the home decides whether or not it can care for people who might want to live at Epworth Care Home, what information is gathered about those potential residents, and what methods are used to do that. The inspector also looked at how care is then planned and provided for the people who do come to live there. The inspector looked at how much individual attention was paid to resident’s needs, to their likes, their dislikes and to how residents wanted to lead their lives and be cared for. The inspector looked at how well these things were recorded, how well these were understood by the home’s staff, put into practice, and what residents thought about their care. Before the inspection, the inspector received a completed questionnaire from the registered manager covering the current details of staff and residents and the main arrangements for providing care. The inspector also received 10 written questionnaires from residents, and 2 written questionnaires from residents’ relatives, giving their personal views about how satisfied they were with the care at Epworth. The inspection itself was assisted by the home’s registered manager, Mrs Pauline Hardy, and by the home’s acting line manager, Mrs June Pearson. During the inspection the inspector spoke privately and at length with 3 members of the home’s care team and with 3 residents of the home, and 1 relative of a resident. The inspector also looked at care records relating to the 3 residents spoken with.
Epworth Care Home B54 S63231 Epworth V228319 180705 Stage 4.doc Version 1.40 Page 6 The building was not the main focus of this inspection, but the inspector did see some bedrooms, public areas, and service facilities, upstairs and downstairs, and the general impression was of a comfortable and clean environment. On the day of the inspection 17 residents were being cared for. What the service does well:
Residents thought that they were very well cared for by the staff of the home and spoke of their trust in and appreciation of the staff. “I like them all. They are very friendly, and any visitors I get, the girls make them very welcome when they come.” “I like to do things for myself, but if I need some help and ring the buzzer, they’re here in a minute. They’re good, anything you want and they’ll see to it.” “You can’t fault any of those girls. They are very pleasant, very welcoming.” “If I had any concerns I would go to Pauline. She’s in charge. She’s a nice girl and she’s very pleasant.” Residents thought that staff understood their care needs and encouraged residents to develop their own every day routines. “I haven’t to go anywhere or do anything I don’t want to. I like sitting here in my own place. I’m cared for by different ones, and they’re all good. I can’t walk very well or see very well but I can decide things myself.” “I like to do things that I can for myself. I don’t like people running after me. I get help when I need it and the staff know that.” Management and staff spoke of the home’s “Family orientation, strong visiting culture, and good working relationships.” Comments were made on how, “ Staff are very accommodating, very flexible, very involved, which works well for residents and makes them feel at their ease.” The inspector thought that staffing the home in excess of the current national levels, the caring attitude of staff, and the introduction of an activities coordinator will help ensure residents are well looked after at Epworth Care Home.
Epworth Care Home B54 S63231 Epworth V228319 180705 Stage 4.doc Version 1.40 Page 7 What has improved since the last inspection? What they could do better:
The home is changing many of its records, systems and the general arrangements it has for making sure residents are safe and well cared for. At the moment, some of these changes are partly complete, and there is a mixture of old arrangements about to be replaced and new ones already in place. This is a major task that will take time and effort to complete, but there is a lot of support for and interest in these changes at the home. These changes have began to improve the home already, and the inspector would look for evidence that these changes are more established at the time of the next annual inspection. Broadly, these improvements are not about how the home might meet minimum standards, but how these might be exceeded. It was noted that the home now has 30 of care staff with NVQ2 but has plans to meet the 2005 target to have 50 of care staff with NVQ2.
Epworth Care Home B54 S63231 Epworth V228319 180705 Stage 4.doc Version 1.40 Page 8 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. Epworth Care Home B54 S63231 Epworth V228319 180705 Stage 4.doc Version 1.40 Page 9 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 Epworth Care Home B54 S63231 Epworth V228319 180705 Stage 4.doc Version 1.40 Page 10 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. Epworth Care Home’s admission procedures ensure that anyone thinking about moving into the home has a proper assessment. The home sees this assessment as a necessary first step in deciding whether or not they can meet that person’s needs, and an important source of information for designing and directing future care. EVIDENCE: The inspector looked at the needs assessment records of 3 residents and spoke to those 3 residents about their care. The care needs described in the 3 needs assessment records and the care needs described by the 3 residents themselves were very similar. The inspector spoke to 1 senior and 2 junior members off the home’s care staff team. All 3 staff showed a good understanding of the needs of the residents in their care and all 3 saw written assessment and care planning information as a very important source of information. Epworth Care Home B54 S63231 Epworth V228319 180705 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9, & 10 Arrangements are in place to ensure that the health personal and social care needs of residents at Epworth Residential Care home are identified and met in a way that respects the privacy and dignity of residents. The home’s previous arrangements were quite sound but recent work has been done in the home to further develop the planning and recording of care for the benefit of their residents. EVIDENCE: The inspector was able to compare the layout of the old plans of care with the new plans of care drawn up for 3 residents, and saw the daily records relating to these 3 residents. In all 3 cases each aspect of health, personal, and social care need was identified and a plan for meeting these was provided. The information in the new plans looked easier to read and use. What people’s likes and dislikes were, their interests and daily habits, their needs, and ways to meet those needs were more clearly set out than they were before.
Epworth Care Home B54 S63231 Epworth V228319 180705 Stage 4.doc Version 1.40 Page 12 The registered manager and acting line manager of the home said that they were making a major effort to make care plans more useful and to involve more people in drawing them up and maintaining them. The 2 junior care staff spoken with by the inspector said that they were becoming more involved with care plans than they had been, gathering and entering information, making sure the plan was followed and noting any changes that they thought might be necessary to make. Although staff valued their own good personal understanding of resident’s needs and being able to talk these over with fellow workers, they also thought written records and written plans were important ways of making sure residents’ needs were understood. The 3 residents who spoke with the inspector thought that staff treated them with respect and the 3 care staff who spoke to the inspector were very clear about the need to show that respect, and support the privacy and dignity of residents. One resident said, “ The girls are very pleasant, I couldn’t fault them. In fact they spoil us a bit. On a night they’ll knock on my door, pop their heads round and say, “ I’m just seeing that you got into bed alright.” I had a few falls when I was living at home. I can do a lot for myself, but it’s nice to know they are there.” One member of staff said, “ Privacy and dignity is important. If the person isn’t aware of it for themselves then you have to be. You have to be discrete. You have to do things with people, not to them, you have to explain what you are doing and try to get them to agree and to help if they can.” Epworth Care Home B54 S63231 Epworth V228319 180705 Stage 4.doc Version 1.40 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 standard(s) 12,13,14, & 15. The home works hard to recognize and respond to residents at Epworth Care Home as individuals who might not like to do the same things in the same way as others living at the home. The home values its close family and community ties. The home tries to respect and support the decisions of its residents and hopes to provide them with some everyday pleasures and satisfactions. EVIDENCE: The 3 residents who spoke at some length with the inspector, about their daily lives, said there was a good balance between the time they spent alone and the time they spent with others and that they had a fair bit of control over this, and over what they did or did not take part in. One resident said watching a television with a lot of other people was the last thing they would want to do, but that they got a lot of pleasure from sitting in their bedroom listening to radio programmes. This resident said staff knew that although they did not like the television they did like singalongs and would always go to those. Another resident said they liked to be asked to take part in things even though they usually declined, and that there was no pressure to say yes or worry about not being asked again if they said no. The registered manager, the staff, the residents and a resident’s relative said the home was very welcoming of visitors and that people were often known to each other in the past as neighbours and friends in years gone by. Everyone thought this was one of the strengths of the home. A member of staff said of
Epworth Care Home B54 S63231 Epworth V228319 180705 Stage 4.doc Version 1.40 Page 14 one of the residents, “ When I was little, that lady had a lovely garden and I always remember seeing her in it, and we often talk about it.” The staff of the home who spoke to the inspector had a very strong interest in making sure people living at the home did have choice and control over their lives and showed an understanding of how important that was, as well as how difficult that could be sometimes. One member of staff said to the inspector, “It’s down to choice. You can encourage, but you can only take that so far.” Another member of staff said, “You have to respect people’s wishes, you always need to be careful, and to make sure people are safe. There may be some difficulty that a resident has, but if they don’t accept there’s a difficulty, then you have to accept that, and just be as vigilant as you can, and keep working at it.” There was a general view among residents, management and staff that the food in the home was good and was in fact better than it ever had been. There was more choice than there was previously and this was very much appreciated. 2 residents told the inspector, “I’m not a big eater. One knife and fork meal a day is enough for me. I wouldn’t thank you for a big breakfast and I like a sandwich at tea time and that’s what I get. Others like a big breakfast and get one and if they like a big tea then they can get it.” and, “Staff come around the night before and ask what you would like the next day. I always like to find out what other people are having and I might say I fancy a bit of that as well.” Epworth Care Home B54 S63231 Epworth V228319 180705 Stage 4.doc Version 1.40 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 standard(s) 16 & 18 The home has proper complaints and protection procedures, and people living working and visiting the home are aware of these. There is also good communication between those people on a formal and informal level. This openness and an awareness of individual expectations, satisfactions, dissatisfactions and preferences also ensure that residents are listened to and protected. EVIDENCE: The 3 residents spoken with by the inspector were very happy with their care and with their carers and spoke very highly of both. They thought it unlikely that they would need to complain, but if they had to they would go straight to the manager without any hesitation. The home’s registered manager and acting line manager told the inspector that residents had just been issued with new information packs which includes information about how to make a complaint. One of the residents also mentioned this pack to the inspector. Staff interviewed by the inspector mentioned just completing a course running over 12 weeks on the protection of vulnerable adults, and were quite clear about the issues around protection, their responsibilities, and how to take action if they suspected abuse. The home’s registered manager and acting line manager were interested in developing the role of the new activities coordinator in supporting the existing system for gathering views from residents about their levels of satisfaction
Epworth Care Home B54 S63231 Epworth V228319 180705 Stage 4.doc Version 1.40 Page 16 with the care provided in the home as another means of ensuring residents were listened to and protected. Epworth Care Home B54 S63231 Epworth V228319 180705 Stage 4.doc Version 1.40 Page 17 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) Not assessed on this occasion. EVIDENCE: Epworth Care Home B54 S63231 Epworth V228319 180705 Stage 4.doc Version 1.40 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 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. The deployment and number of staff available day and night meets the needs of residents. The weekly hours provided exceed the current standard national calculation used for care staffing in care homes for 17 older people. EVIDENCE: The home provides 3 care assistants throughout the waking day, from 8am to 9pm and 2 care assistants on night duty from 9pm to 8am. In addition the home has a full time manager, 2 domestics (16 hours each), 2 cooks( 30 hours and 18.75 hours), 1 kitchen assistant (19.5 hours), and support from a handyman and an administrator shared with another home. A 12 hours per week activity coordinator has also been provided. Epworth Care Home B54 S63231 Epworth V228319 180705 Stage 4.doc Version 1.40 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) Not assessed on this occasion. EVIDENCE: Epworth Care Home B54 S63231 Epworth V228319 180705 Stage 4.doc Version 1.40 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 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 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 4 28 x 29 x 30 x 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 x x x x x x Epworth Care Home B54 S63231 Epworth V228319 180705 Stage 4.doc Version 1.40 Page 21 no 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 Regulation none Requirement Timescale for action 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 3, 7, & 12. Good Practice Recommendations It is recommended that the home should follow through with its present plan to further develop its assessment and planning of care, and the homes arrangements for providing a programme of activities, for residents. It is recommended that the home should follow through with its present plan to have 50 of its care staff achieve NVQ2 in 2005. 2. 27. Epworth Care Home B54 S63231 Epworth V228319 180705 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection No 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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