CARE HOMES FOR OLDER PEOPLE
Evelyn Wright House 32 Badby Road Daventry Northants NN11 4AP Lead Inspector
Mrs Pat Harte Unannounced Inspection 1st December 2005 11:05 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 Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 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. Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Evelyn Wright House Address 32 Badby Road Daventry Northants NN11 4AP 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) 01327 703140 01327 312775 www.northampton.gov.uk Northamptonshire County Council Mrs Sharon Alma Towers Care Home 29 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (29), of places Physical disability over 65 years of age (4) Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. No person falling within the category OP can be admitted where there are already 29 persons of category OP already in the home. No person falling within the category DE(E) can be admitted where there are 11 persons of category DE(E) already in the home No person falling within the category PD(E) can be admitted where there are 4 persons of category PD(E) already in the home To be able to continue to accommodate the named person of category MD(E) who was accommodated in the home prior to registration in 2002 Total number of service users in the home must not exceed 29 Date of last inspection 18/04/05 Brief Description of the Service: Evelyn Wright House provides permanent care for up to 29 Elderly Residents. There are places for up to 11 Residents with Dementia and 4 with Physical Disabilities. The Home has an additional condition to continue to provide care for one existing Resident with Mental Disorder. The Home is owned by Northants County Council. The Manager is Mrs. S. Towers. The Home is situated close to the town centre of Daventry and it’s amenities. The premises provide ground floor accommodation for all Residents. The Home is set back from the road and has secure garden areas to the rear. Residents are accommodated in four units each with lounge/dining/ toilet, bathrooms and bedroom areas. In addition there is a communal lounge area at the front of the Home. All Residents are provided with single bedrooms. One unit is currently dedicated to the care of Residents with Dementia needs. Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for Service Users and their views of the service provided. Inspection planning took one hour and consisted of a review of the last inspection report and requirements, the Home’s service history including notifications and events. The primary method of inspection used was ‘case tracking’ which involved selecting two Residents and tracking the care they receive through review of their records, talking with them and the care staff. In addition four staff, six Residents and one visiting Relative were spoken with to gain their opinions on the service. A partial tour of the premises took place, a selection of records was inspected and observations made on care practices. Discussions were held with the Registered Manager. The Inspection took place from late morning and in the afternoon over a period of four and a half hours and was carried out on an unannounced basis What the service does well:
The Home has a committed staff group. Residents spoken to felt that their relationships with staff were very good and that staff provided them with good care and support and valued and respected as individuals. Routines are relaxed and flexible and Residents confirmed that they are enabled to continue the routines they have followed through their lives and maintain their independence as much as is possible. Staff ensure that Residents Health Care needs are closely monitored with prompt referrals made to Medical Professionals where necessary. Residents with Dementia care needs are well supported, supervised and monitored. Meals are varied, well balanced, of good quality and nicely presented. Residents stated that they are given a good choice of options in the daily menu and account is taken of their likes and dislikes and special diets.
Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 Page 6 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. Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 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 Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 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 the following standard(s): 1, 3, 4 & 5 Prospective Residents are provided with information to enable them to make informed choice regarding their placement. The pre-admission assessment is thorough and effective in ensuring that the needs of people admitted to the home can be met. EVIDENCE: The admission process ensures that all prospective Residents are visited and assessed by staff from the Home to ensure their needs can be met. Residents and their relatives have opportunities to visit the Home and are given information on the services and facilities. Residents spoken with felt that staff were well briefed on their needs and the care to be provided. Staff spoken with felt that they were provided with good information on their Residents needs, routines and wishes. Individual records are kept for each of the Residents and inspection of the records showed that the assessment process was thorough, specific
Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 Page 9 assessment tools were used to identify needs and risk and assessments were carefully documented. Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9 & 10 Care plans clearly documented Residents needs and provided a good level of instruction and guidance for staff on how the care was to be carried through including guidance on how Resident’s with Dementia are to be supported. EVIDENCE: 65 of all Care plan formats have been reviewed and updated to a new format. Two Residents care plans were inspected. The plans showed a holistic approach and detailed guidance and instruction for staff on how the care was to be provided though the timings for some routines were not detailed in all instances. Attention has been paid to ensuring that information is gathered on Residents’ Life Histories with specific attention given to the histories of Residents with Dementia. Written strategies for the management of behaviours for Residents with Dementia are being developed. Staff commented that the level of information
Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 Page 11 gathered from life histories and the improved guidance and instruction on the care plans gave them a better understanding of Residents needs and enabled them to communicate more effectively. The care plans showed that account is taken of Residents wishes in relation to their preferred routines and how the care is to be provided. Plans detailed tasks that Residents’ could undertake for themselves showing that they were encouraged to maintain their independence as much as possible. Residents also stated that they felt respected and valued as individuals and encouraged to take control of their lives. Health care needs were clearly documented. Residents commented and records showed that staff responded quickly to any changes and made referrals to the appropriate Medical Professionals. Residents were enabled to see their General Practitioners quickly. Care plans gave clear instructions on how staff were to monitor health needs. The care plans did not always reflect the emotional support provided to Residents although it was clear from discussions with Residents that staff noted their moods and events that had affected them and were quick to respond and provide support. Procedures were in place for the management of Medication. Storage of medication was appropriate and safe. The mid day medication round was carried through safely and efficiently. The required records were well maintained. Observations confirmed that Staff ensure the protection of Residents privacy and dignity when carrying through personal care. Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14 &15 Residents are enabled to maintain their independence as much as possible and exercise control and choice in the way they wish to lead their lives. The meals in the Home are good, offering choice and variety and catering for special dietary needs and individual likes and dislikes. EVIDENCE: Residents felt routines were relaxed and flexible and that their personal preferences on areas such as rising and going to bed times were respected. They felt that they were free to decide on how and where they wished to spend their time and that they were encouraged to maintain their independence as much as possible and allowed to do things for themselves. The Home has an open visiting policy and Residents confirmed that they were enabled to receive their visitors in private if they wished. A visiting Relative spoke of how she was always made welcome, extended hospitality and given time to discuss her Residents progress with staff. The Home is developing the activity programme and provides activities on both a group and individual basis. Residents confirmed that staff found time to sit and talk with them.
Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 Page 13 A number of Residents were spoken to and everyone who commented on the food said it was good, that they had choice and their special and likes and dislikes were catered for and respected. Residents order their meals in advance and the menu sheets details the quantities of food required. Residents are asked to comment and offer suggestions on the menu and changes are made accordingly. The midday meal was efficiently served and nicely presented. Staff helped Residents with their meals where necessary. Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 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 the following standard(s): 16 & 18 Systems are in place to protect Residents from abuse and to ensure that complaints are listened to and acted upon. EVIDENCE: Residents confirmed that they had been given the Home’s complaints procedure which is also displayed in the Home. They stated that they felt confident and able to raise any issues or concerns with the staff or the Manager and were confident that action would be taken to resolve any issues. A complaints record is maintained. No complaints have been received by the CSCI. Robust procedures for the Protection of Vulnerable Adults are in place. Staff demonstrated, through discussions, their full understanding of the reporting procedures. Records and notifications received by the Commission confirm that allegations are reported to the relevant Authorities. Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Residents are provided with a well-maintained, comfortable and homely environment. EVIDENCE: The premises were in good order, clean, warm, comfortable and well maintained. Since the last Inspection considerable refurbishment and maintenance work has been carried out to improve the appearance of the Home and address safety issues. New fencing has been provided to the rear garden areas to enhance security. A new sensory garden for Residents with Dementia is being created for their enjoyment. Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 Page 16 Attention has been paid to security issues in respect of alarming exit doors to ensure Residents with Dementia do not leave the building unnoticed. One fire exit door is currently awaiting the fitting of an alarm. A tracking hoist has been fitted to a bathroom to ensure that Residents with physical disabilities can easily and safely bathe. Standards of domestic and hygiene maintenance were viewed as very good. Residents stated that cleaning routines were carefully organised to ensure no disruption to their routines. Residents are enabled to personalise their rooms as they wish and have their furnishings and belongings around them. Due attention was paid to ensuring a safe environment. Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 & 30 Sufficient numbers of care staff are deployed to meet the needs of current Residents. EVIDENCE: Residents spoken with said that the staff were very kind, committed and caring. Relationships between staff and Residents were observed to be good and it was clear that staff interacted well with their Residents. Four care staff are deployed on all daytime shifts. In addition at least one Residential Care Supervisor is on duty to lead and oversee the shift. 2 Night carers provide night care. Currently one specific carer is deployed the unit dedicated to the car eof Residents with Dementia on all daytime shifts. This has brought a continuity and consistency of care with Residents becoming familiar with and recognising the staff. Residents are carefully monitored and supervised. Ancillary staff include Catering, Domestic staff and a Handyman ensuring that care staff are free to care for their Residents. Discussions with the Manager, staff and Residents confirmed that the staffing numbers were sufficient for the current needs of the Residents, staffing can be adjusted where necessary.
Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 Page 18 Staff were observed to respond quickly to call bells and Residents requests for assistance. Discussions with staff confirmed that they are provided with core training and regular updates. Specialist dementia care training has also been provided and staff are encouraged to undertake a National Vocational Qualification. Staff spoken with showed a commitment to the well being of their Residents and knowledge of the Home’s aims and objectives and policies and procedures. Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36 & 38 The Management of the Home is effective and the home is run in the best interests of the Residents. EVIDENCE: Staff spoken with felt that the Managers were easily accessible to them and was willing to discuss any issues, lead and guide them in practice and offer support. They confirmed that systems for informal as well as formal supervision were in place. Residents felt the Manager was readily available to them. They commented that regular Residents meetings were held and that the Manager consulted with them and sought their individual views and opinions. Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 Page 20 Residents felt that they had trust and confidence in both the Manager and the staff group as a whole. The Manager and senior staff team have worked very hard to improve practices and develop the care plans. All previous requirements have been met. Due attention was paid to Health and Safety. The fire records showed that the systems were well maintained and tested in accordance with the Fire Officer’s recommendations. Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 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. 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 3 X 3 3 3 N/A 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 Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 3 Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 Page 22 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. Refer to Standard Good Practice Recommendations Evelyn Wright House DS0000034870.V253079.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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