CARE HOMES FOR OLDER PEOPLE
Epworth Care Home Front Street Tanfield Lea Stanley Durham DH9 9LX Lead Inspector
Gavin Purdon Unannounced Inspection 24th October 2006 10:00 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 Epworth Care Home DS0000063213.V315541.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. Epworth Care Home DS0000063213.V315541.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Epworth Care Home Address Front Street Tanfield Lea Stanley Durham DH9 9LX 01207 236379 01207 290853 Epworth.health@btconnect.com www.x9healthcare.com X9 Healthcare Epworth Limited 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) Mrs P Hardy Care Home 31 Category(ies) of Dementia - over 65 years of age (31), Old age, registration, with number not falling within any other category (31) of places Epworth Care Home DS0000063213.V315541.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17th January 2006 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. The home is owned by a private company, X9 Health Care Epworth Ltd. 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. There is a plan to develop some outside amenity space and off road parking for the home. The home’s charges range from £364.50 per week to £398.50, depending on the type of care required. These charges are in line with the local authority’s set rates. Residents have no fixed additional charges for extra services apart from a £15 charge if a resident needs to be accompanied to hospital and a relative is not available to escort them. The home can be contacted by fax on 01207 290853, by e-mail on Epworth.health@btconnect.com, and via the website at www.x9healthcare.com. Epworth Care Home DS0000063213.V315541.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place at very short notice to the home, and is classed as unannounced. It lasted 3 hours and 50 minutes. The inspection was supported throughout by 3 members of the home’s management team, including the home’s registered manager, who came in on her day off to help with the inspection. The registered manager provided written information about the running of the home in advance of the inspection. Other information received from the home since the last inspection, regarding its conduct and management, was also looked at again in preparation for this inspection. During the inspection a range of records were seen and discussed with the home’s management team. These included, resident care records, staff personnel records, and health, safety, and maintenance records. There was also an opportunity to see some of the facilities of the home, and to speak in private with 2 residents and 2 care staff. What the service does well:
Epworth Care Home has scored well across all 7 main areas of care standards inspected. Some of the individual standards achieved in those 7 areas are particularly good. Epworth Care Home has particularly good arrangements for giving residents opportunities for social, cultural, and recreational activities on a daily basis. The home has an activities coordinator who works each day, Monday to Friday. This provides very good support for the individual interests of residents. Epworth Care Home has particularly good arrangements for meeting the care needs of residents in a thorough manner. The home has very good staffing levels with a variety of skills and complimentary roles, covering domestic and kitchen duties, social activities and care provision, through to management, administrative and maintenance support. This is very much to the benefit of residents. Residents spoke very highly of their own experiences of living at Epworth Care Home. Residents found staff approachable, sensitive, and ready to treat people as individuals with different needs and preferences.“ Staff will help you with anything. Nothing’s a trouble to them. They are very kind people. They all look after you. You are not frightened to ask anything.” And, “ You can keep your independence. I can do things for myself, and maybe I’m a little bit
Epworth Care Home DS0000063213.V315541.R01.S.doc Version 5.2 Page 6 luckier that some. You can make your own bed if you want. You might tell people as a matter of courtesy what you are going to do. You don’t need anybody’s permission.” The home tries to maintain a 100 level of staff training to NVQ level 2 in Care, which is well above the expectations of the National Minimum Standards, and the high level of training activity in the home must contribute to the good care experiences of residents at Epworth Care 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Epworth Care Home DS0000063213.V315541.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Epworth Care Home DS0000063213.V315541.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. (Standard 6 does not apply to this service.) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents coming to live at Epworth Care Home have their care needs carefully assessed. This means that the home knows at an early stage what kind of care is required and whether or not they can provide it in a way that suits the resident. EVIDENCE: 2 examples of assessments were seen. 1 was completed by a local authority social worker, and 1 was completed by the registered manager of Epworth Care Home. Both assessments were well organised, carefully completed, and contained good practical information useful in drawing up an individual care plan for the residents concerned. Epworth Care Home DS0000063213.V315541.R01.S.doc Version 5.2 Page 9 The assessment done by the home’s registered manager was thoroughly completed and a good example of this kind of document, but the individual sections of the assessment were not signed and dated, as they should have been. Epworth Care Home DS0000063213.V315541.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from comprehensive individual care plans that cover their whole range of care needs equally well, whether health, social, or personal needs. Residents benefit from the home identifying their health care needs and arranging for these to be properly met. Residents are protected by the home’s arrangements for dealing with medication safely and in a way that recognises the individuality of each resident. Residents benefit from the home ensuring they are treated with respect and have their right to privacy upheld. Epworth Care Home DS0000063213.V315541.R01.S.doc Version 5.2 Page 11 EVIDENCE: The 3 care plans seen were all well developed and covered the full range of care needs in equal detail. Discussion of these care plans with the home’s management team showed how the health care needs of individual residents were identified, and responded to in a proper manner, including the use of risk assessments, obtaining and acting on professional advice, and arranging specialist services. Discussion with 2 of the home’s residents, and with the home’s management team and care staff, showed that residents were spoken to and written about in respectful way, and that the home was very sensitive about protecting the privacy of its residents in how information was kept and who that was shared with. Epworth Care Home DS0000063213.V315541.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents, who wish to, can benefit from the home’s ability to provide a wide range of opportunities for social, cultural and recreational activities on a daily basis. Residents, who wish to, can benefit from the home’s readiness to support their contact with family, friends, or others, and with the local community at large. Residents benefit the home helping them to have some choice and control over their daily lives. Residents benefit from the home recognising the social importance of mealtimes and the health implications of diet. Epworth Care Home DS0000063213.V315541.R01.S.doc Version 5.2 Page 13 EVIDENCE: Records seen, and discussions with residents, management, and staff, showed that the home has a substantial programme of daily activities and involvement with residents on a social and recreational basis. This involves small group work or 1 to 1 individual attention. The home has an activities coordinator who works 5 hours a day, Monday to Friday. This provides a very good opportunity to support each resident’s individual interests. Residents said that their visitors were always made welcome by the home. One resident said,“ If my sons and daughter come in at night, the staff don’t leave them out, if they want a cup of tea as well. The family call in to see me. The home is handy for that, and the girls are very nice with them.” Another resident said, “My daughter works, but she might drop in, and they always offer your visitor a cup of tea.” Residents, management and staff thought that people living at the home have a comfortable way of life that suited them and did not restrict them in unnecessary ways. A resident said, “You can keep your independence. I can do things for myself, and maybe I’m a little bit luckier than some. You can make your own bed if you want. You can stay in bed if you want. You might tell people as a matter of courtesy what you are going to do. You don’t need anybody’s permission.” Residents spoken to were happy with the meals. “You get what you want for breakfast, a bacon sandwich, cornflakes, or Weetabix. There was mincemeat, carrots and turnip today. It was very good. Then there was ice cream. They come around with tea and coffee.” The management team said that the quality and quantity of food bought was good and explained how careful attention was paid to individual residents with particular dietary needs or conditions connected with eating. Epworth Care Home DS0000063213.V315541.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives benefit from the home’s interest in listening to what people think about the care provided and responding to that in a positive way. The home has policies, procedures, and practices that help protect residents from abuse. EVIDENCE: From discussion with management, staff, and residents there was good evidence of mutual respect and trust between those staff and residents. There was good evidence of views being shared and acted on. A resident said, “Staff will help you with anything. Nothing’s a trouble to them. They are very kind people. all look after you. You are not frightened to ask anything.” A senior member of care staff organises satisfaction surveys and these are passed on to management to be dealt with. The home is very interested in hearing what people have to say and responding to that. Epworth Care Home DS0000063213.V315541.R01.S.doc Version 5.2 Page 15 This open approach is backed up by formal procedures. Notices about the complaints process are posted in the home with individual copies provided for residents. All care staff have completed Protection of vulnerable Adults training. Staff have clear guidance of how to respond to abuse, and adult protection referral forms are included in the handbook issued to staff. Staff spoken to were very clear about the action they would take in the event of abuse. “I would report any abuse, and would have no qualms about doing it. I would not want to be associated with anything like that or anyone doing it.” Epworth Care Home DS0000063213.V315541.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the benefit of living in a safe and well-kept home. Residents have the benefit of living in a home that is clean, pleasant, and hygienic. EVIDENCE: The home has a very organised approach to safety and maintenance matters. There are ongoing checks completed on a weekly, monthly, and occasional basis. Environmental assessments are made. A maintenance book is used to log work scheduled, required, and completed. Work is undertaken by outside contractors and by in house staff.
Epworth Care Home DS0000063213.V315541.R01.S.doc Version 5.2 Page 17 Significant work has been completed to improve lighting standards and gas safety in the home. Domestic work is completed in line with a set rota of tasks, and a record of work kept. A resident said, “I like the home it’s very nice. You couldn’t get any better. I have a nice room. It’s nice and warm. I’m quite content.” Another resident said, “ I’ve always had the same room. I like it, it’s warm. I can go along to the lounge, watch telly, and sit and talk. I’m happy with the care.” The bedrooms, lounge areas, and corridors seen on the day of the inspection were clean, pleasant and odour free. Epworth Care Home DS0000063213.V315541.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29, & 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The very good staffing levels, and the variety of skills and roles of staff at Epworth Care Home, make it possible for staff to meet the needs of residents in a very thorough manner. The high level of qualifications in the staff group at Epworth Care Home helps ensure that residents are in safe hands at all times. Residents are protected by the home’s thorough recruitment policies and practices. The thorough staff basic training and development programme at the home helps ensure staff are competent to care for residents. EVIDENCE: Staffing arrangements were discussed with management and staff and with residents. The home has 21 residents. During the waking day, 8am to 8pm, there are 3 care staff on duty, 1 of them a senior care. On night duty there are 2 care staff, 1 of them a senior care. Staff are well supported, by a full time manager, and an activities coordinator working 10am to 3pm 5 days per week.
Epworth Care Home DS0000063213.V315541.R01.S.doc Version 5.2 Page 19 Kitchen staff are 1 full time and 1 part time cook, supported by a part time kitchen assistant. The home also has the benefit of its own 20-hour handyman, and an administrator that it shares with another home belonging to the same owner. Residents spoke very highly of staff, and felt well cared for and well treated by them. 1 resident said staff, “ Will help you with anything. Nothing’s a trouble to them. They all look after you.” And, “The girls are very nice. You couldn’t get any better.” Care staff also thought that the staff group were very supportive with each other as well with the residents, “The girls are wonderful. They will help you in any way they can. I enjoy working with them.” Epworth Care Home tries to maintain the very high ratio of 100 care staff with the NVQ level 2 qualifications in Care. All senior care staff are taking the NVQ level 3 qualification in Care. The personnel file of the most recently appointed member of care staff was seen, and the recruitment and selection process was discussed with the registered manager and with the member of staff concerned. All the necessary procedures had been followed and documents provided to ensure the identity and the suitability of staff to care for vulnerable residents. The home has an organised training and development programme for staff. This was discussed with management and with staff. Records were seen confirming induction foundation training undertaken by new staff. The registered manager outlined recent further training held for staff. Staff spoken with showed a very positive attitude towards training, and some pride in their achievements. Epworth Care Home DS0000063213.V315541.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and staff benefit from having a fit and competent manager to run their home. Residents benefit from the home’s well-developed interest in quality assurance which ensures that their views about the care they receive are known and acted on. The home makes sure that money kept for residents, and spent on their behalf, is properly protected by keeping clear records and receipts. Residents and staff are protected by the safe working practices at Epworth Care Home. Epworth Care Home DS0000063213.V315541.R01.S.doc Version 5.2 Page 21 EVIDENCE: Staff and residents of the home thought that the registered manager was approachable and supportive, and that the whole management team, from the senior carers upward, were all very helpful and capable. The registered manager holds the NVQ level 3 qualification in Care, and is about to complete the Registered Manager’s Award. The home is interested in what residents think about their care. These views are gathered, discussed and presented in a very readable fashion in the home’s newsletter. A recently published example was seen during the inspection. The records of money kept and spent on behalf of a resident were looked at and these were accurately kept and up to date. The home has well developed and well kept formal records to support the health and safety of residents and staff. These were seen during the inspection and discussed with the management team. As might be expected, the home keeps quite extensive records relating to all fire safety matters, including training and maintenance, but the details of drills held could be improved. Epworth Care Home DS0000063213.V315541.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 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 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 4 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 Epworth Care Home DS0000063213.V315541.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation 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 OP3 Good Practice Recommendations The example seen of an assessment done by the home’s registered manager was thoroughly completed and a good example of this kind of document, but the individual sections of the assessment were not signed and dated, as they should have been. Signing and dating sections can be useful for reviewing care needs and tracking how these may have changed or stayed the same over. The home keeps a record of all fire drills held, but could improve its fire drill records by noting which members of staff attend which particular fire drill. 2. OP38 Epworth Care Home DS0000063213.V315541.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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