CARE HOMES FOR OLDER PEOPLE
Edge Leigh Blackstone Edge Old Road, Littleborough, Rochdale, OL15 0JG. Lead Inspector
Tracey Devine Unannounced 06th 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. Edge Leigh F56 F06 S25471 Edge Leigh V224960 060505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Edge Leigh Address Blackstone Edge Old Road, Littleborough, Rochdale, OL15 0JG. 01706 378938 01706 379919 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) Ashbourne Homes Ltd CRH - Care Home Only 53 Category(ies) of DE - Dementia 60 - 65 years (1) registration, with number DE(E) - Dementia over 65 years (37) of places OP - Old age over 65 years (15) Edge Leigh F56 F06 S25471 Edge Leigh V224960 060505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Within the maximum registered number of 53 places there can be up to: 15 Older People OP - (Older people over 65 years of age) 37 Adults with Dementia over 65 years of age DE(E) - (Dementia over 65 years of age 1 Adult with Dementia DE - (Dementia) (60 - 65 years) The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 22 September 2004 Brief Description of the Service: Edgeleigh is a care home providing personal care for up to 53 older people. Nursing care is not provided. The home is a conversion of two semi detached houses, which over the years has been extended to provide a home on 3 levels with a neighbouring bungalow connected through the provision of a covered walk-way. Local shops and access to the rail network is within easy driving distance of the home. A combination of single and double bedrooms are available and a passenger lift services all levels of the home. The home is split into two distinct units, one for residential care and one for dementia care. The dementia care unit is located on the ground floor, with bedrooms provided on the ground and the 1st floor. The residential unit is sited in the bungalow, with some provision of bedrooms sited on the 1st and 2nd floor. Ample car parking is available to the front of the home, and a rear enclosed garden is provided. Access to the garden is though the dementia care unit. Access to the dementia care unit is via a key coded pad, and internally the home has a number of ramps connecting the various levels of the building.
Edge Leigh F56 F06 S25471 Edge Leigh V224960 060505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 8.5 hours by two inspectors and was unannounced. Since the last inspection, 2 additional visits have been made in response to complaints received by the CSCI, and copies of the summaries of these complaints can be obtained from the CSCI office on request. As a result of the complaints made, additional visits have been made to the home by the CSCI to ensure that improvements have been made. If the improvements required are not maintained, it is possible that the CSCI will consider enforcement action. The majority of the residents at the home suffer from dementia and their ability to communicate effective is impaired. As such, it was not possible to seek direct feedback from them on the service provided. Therefore inspectors have relied on observations, discussions with staff, and looking at record keeping to make their judgements. Inspectors did speak with 2 residents on the residential unit regarding the service at the home. What the service does well: What has improved since the last inspection?
Since the last inspection, the layout of the communal areas on the dementia care unit has been changed and now provides a more homely design. Most of the requirements made at the last inspection have been complied with. Edge Leigh F56 F06 S25471 Edge Leigh V224960 060505 Stage 4.doc Version 1.30 Page 6 What they could do better:
Staff have limited skills and knowledge in how to care for residents with dementia. They have not been properly trained or supervised and this has resulted in many residents being poorly cared for. Staff need to receive training on how to care properly for older people with dementia and how to promote and maintain a person’s dignity when caring for them. Records showed that 19 residents have had a weight loss in the last 6 months. No reasons for the weight loss were provided, and nothing had been done to address the situation. The reasons why residents have lost weight must be established and addressed, including contact to be made with the Community dietician and the residents own GP. Records held in respect of residents (their routines, preferences, interests, care to be delivered) are not widely used by all staff. This resulted in staff having limited knowledge of the care to be provided. Care staff must read the information held in respect of residents in order that they deliver the care required. Activities are in place, but no one knew what was planned. There was little communication between the organisers, care staff or residents. The activities need to be planned to meet the social needs of all the residents. More emphasis needs to be placed on one to one activity, and for entertainment/stimulation other than the TV to be devised. Residents spoken with said they mainly watched TV. Staffing levels are sufficient, however, staff turnover has been high resulting in agency staff needing to be used frequently. Whilst this is not ideal, in the main, it is the same agency staff who work at the home and are therefore able to offer some continuity to residents. The policy of Ashbourne Homes in recruiting staff from overseas has impacted on the makeup of some shifts having more foreign carers than English carers. Whilst this would not normally be a considered to be a problem, the poor language skills of some of the workers makes communication between the carers and the residents difficult, in respect of level of understanding of both and the rapport to be established with residents. Training is offered to staff, and most have undertaken moving and handling training, and training on the prevention of abuse. Training in respect of providing care to those with dementia has not been undertaken by most staff and this must be addressed. Likewise, other training such as first aid etc has not been consistently undertaken by all staff. A full training programme for all staff must be introduced. The home has had 4 investigations into allegations of abuse within the last 12 months, with 1 still ongoing. 2 of the investigations have been proven and the home has dismissed the carers concerned.
Edge Leigh F56 F06 S25471 Edge Leigh V224960 060505 Stage 4.doc Version 1.30 Page 7 3 complaints have also been made to the CSCI regarding poor care at the home, all of which have been largely upheld. The CSCI is undertaking additional visits to the home to ensure that improvements made are maintained. 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. Edge Leigh F56 F06 S25471 Edge Leigh V224960 060505 Stage 4.doc Version 1.30 Page 8 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 Edge Leigh F56 F06 S25471 Edge Leigh V224960 060505 Stage 4.doc Version 1.30 Page 9 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) EVIDENCE: These outcomes will be measured by the CSCI at the next inspection. Edge Leigh F56 F06 S25471 Edge Leigh V224960 060505 Stage 4.doc Version 1.30 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, 10. Residents receive a basic level of care. Care practice does not ensure their safety or uphold their right to be treated with dignity. EVIDENCE: Individual plans of care are available. 3 were looked at and none consistently showed a review of all care needs. The overall review of care which is to completed monthly was brief and often made no reference to specific care needs, or if improvements in general health had been made. Identified areas of need such as loss of weight had been identified, however, no further action was evident as to what care staff were to do with such information, and how a resident’s weight loss was to be addressed and monitored or if a referral to the community dietician or GP was required. Records showed that 19 of the 37 residents had some weight loss over the last 6 months. Care staff are not involved in writing or updating care plans, and generally had limited knowledge of what was contained in them. Information regarding residents is provided at the start of each shift by the senior to staff coming on duty. This was said to vary in content and on occasion may not occur. The quality of the information provided was often said to be very limited, resulting
Edge Leigh F56 F06 S25471 Edge Leigh V224960 060505 Stage 4.doc Version 1.30 Page 11 in some care staff having very little knowledge of the care to be provided to residents. Observations made during the day showed staff had limited regard to residents’ dignity. Senior staff were present on “the floor” whilst poor practice occurred, and made no comment or guidance to staff on how to improve this. For instance, one resident was left sitting alone in the middle of the lounge for some considerable time with little contact made by staff towards this resident. One resident was transferred by staff from his wheelchair to an easy chair using a hoist, his upper clothing became trapped in the sling resulting in his stomach and back becoming uncovered during the transfer. Staff made no attempt to maintain this resident’s dignity during this transfer. Staff assistance to some residents during lunch was poor with staff offering assistance while in passing rather than sitting down and encouraging and assisting residents to eat; and dining chairs were left pushed back from the tables, creating obstacles for residents and a look of abandonment to any visitors. One resident was verbally abusive (swearing) to staff and other residents for the duration of the inspection. A number of residents were observed to become angry with the level of abuse directed at them and others. None of the strategies for managing this behaviour. Although medication was not assessed during the inspection, the medication cabinet was observed to be left unlocked and unattended when the senior went to locate the relevant resident. As the senior was often not within sight of the cabinet, this practice presents a risk of medication being taken from the drugs cabinet without the senior’s knowledge. Edge Leigh F56 F06 S25471 Edge Leigh V224960 060505 Stage 4.doc Version 1.30 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, 15 Residents social and recreational needs, preferences and capabilities were not met. The menu was varied and portion size good, however, there are no systems in place for offering a choice of daily meal to residents. This lack of choice may impact on residents not eating a meal as they dislike it, and this may be a factor in some residents losing weight. EVIDENCE: Two activities organisers are employed and provide up to 20 hours per week collectively. However, no activities programme was in place, and organisers do not consult individual plans of care to gather information on individual residents hobbies and interests. Generally group activities take place on the dementia care unit with residents from the residential unit invited, although most do not join it preferring to stay in the bungalow. As no activities plan was evident, it could not be established with any certainty what activities take place. There was no evidence of one to one activity with residents, nor of specific activities provided geared to the needs of residents with dementia. The TV was seen to be the main focus of the day, although many residents on the dementia care unit were not watching it. There was no use of subtitles for those who had restricted hearing. Residents on the bungalow had more
Edge Leigh F56 F06 S25471 Edge Leigh V224960 060505 Stage 4.doc Version 1.30 Page 13 inclination to watch the TV, although they said this largely was because there was nothing else to do. Music is available but does not seem to be used with any regularity to create a different ambiance or as tool to provide enjoyment or stimulation. Menus were inspected and found to be varied. However, no detail was provided for breakfast although discussion with residents confirmed it to be largely toast, cereals and porridge. A choice of hot meal for lunch and tea is written on the menu but is not offered to residents routinely. This choice used to offered but the practice offering the choices has ceased. No reason for this could be established, and seemed unknown to the management of the home. One resident was known to be allergic to fish, however, when fish was offered weekly to all residents, no alternative substantial meal was offered to this resident, with sandwiches being the alternative provided. Observations of the lunch time meal and service took place on both units. Residents in the bungalow were assisted appropriately and offered additional food. Residents in the bungalow said they received sufficient to eat, and that generally the food was of a good standard. Residents on the dementia care unit (Hillside lounge) received little assistance resulting in at least 2 people not eating their full meal. One resident was still sitting with nearly a full plate of food 1 hour after it had been served. She had received very little assistance from staff and ultimately this meal was removed virtually uneaten. Sandwiches were provided to this resident, but she received no encouragement to eat these, and these to were removed largely uneaten. Staff assisting those more highly dependent residents (Breezehill lounge) made considerable efforts to assist them to eat. However, the way that food was presented, the fact that it could not be kept warm, and the fact that 6 residents were being assisted by only 2 carers made this a difficult task. One visitor commented that the dessert spoons were too large to use when assisting someone to eat. Consideration should be given to providing suitable crockery, cutlery and warming plates. Food and fluid charts were in place for some residents, but were not routinely in use for the 19 residents who have had a weight loss. None of the staff spoken with could identify at what stage a resident’s poor food intake resulted in a referral to a GP or dietician. Jugs of juice are available to residents throughout the day. However, the jugs became warm to the touch, and it was not clear how often they were being refreshed. Ways of resolving this issue were explored and a solution agreed. Edge Leigh F56 F06 S25471 Edge Leigh V224960 060505 Stage 4.doc Version 1.30 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, 18 The complaints system in place enables residents, relatives and staff to make contact with the CSCI. The whistle blowing policy in place at the home has allowed people to come forward and report allegations of abuse, which has resulted in improved training for staff to prevent further abuse/harm to residents. EVIDENCE: The home has a full complaints procedure in place which is clearly displayed in the entrance hall next to the visitor’s book. Policies and procedures for dealing with abuse are available, and training for staff on prevention of abuse and whistle blowing has taken place. Three complaints have been received at the CSCI alleging poor practice. Of these, two were upheld. In addition, the local Adult Care Services of Rochdale Council is currently investigating 1 allegations of physical abuse, and 3 other investigations in respect of abuse have been investigated. 2 of the investigations were proven and Ashbourne dismissed the carers concerned. Following the practice upheld in the complaints, and in the light of current Protection of Vulnerable Adult (POVA) investigations, the CSCI has increased its visits to the home. Ashbourne Homes have been informed that unless improvements made are sustained, enforcement action against the home is likely. Edge Leigh F56 F06 S25471 Edge Leigh V224960 060505 Stage 4.doc Version 1.30 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) EVIDENCE: These outcomes will be measured by the CSCI at the next inspection. Edge Leigh F56 F06 S25471 Edge Leigh V224960 060505 Stage 4.doc Version 1.30 Page 16 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, 28, 29, 30 Staff are suitably recruited, and there are sufficient staff deployed on each shift. However, owing to insufficient training staff are only providing a basic level of care to residents. EVIDENCE: Sufficient staff are employed with support provided from agency staff on some shifts. In the main, the same agency staff work at the home which does provide some continuity for residents. On recent visits, as a result of complaints, there has been concern by the CSCI in respect of staff deployment and supervision, for instance maintaining a staff presence in the lounge areas when residents are present. Difficulties in this respect have now been resolved, with Ashbourne restructuring the rota and bringing an extra member of staff onto nights, and a member of staff starting earlier to assist with the specific duty of breakfast. Staff turnover in the last 12 months has been high, although this is not uncommon for this home. Ashbourne have detailed an action plan outlining how they intend to address this in respect of recruitment of experienced workers and retention of such. In the light of recent complaint investigations, there has been some concern by the CSCI and the local Adult Care Services from Rochdale Council regarding the skill mix and nationality mix of staff. Some shifts have been identified as
Edge Leigh F56 F06 S25471 Edge Leigh V224960 060505 Stage 4.doc Version 1.30 Page 17 having predominately foreign nationals on duty with limited English speaking skills. As the home caters for people with dementia whose communication skills may be impaired by their dementia, it is therefore not conducive to good care for residents to be cared for by someone whose communication skills are also somewhat limited. Ashbourne have restructured the rota to ensure that the skill mix and nationality mix is more evenly spread. The contents of the 3 staff files were looked at. 2 references and a police check were contained on 2 files, with the 3rd file having only 1 reference on. The manager said she was chasing up this reference. 5 members of staff were asked about what training they had received, and were asked questions based on a scenario - or as a result of observation - to test their understanding. It was clear that for some members of staff, the training had been insufficient, for example, in relation to fire safety and infection control. Edge Leigh F56 F06 S25471 Edge Leigh V224960 060505 Stage 4.doc Version 1.30 Page 18 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) EVIDENCE: These outcomes will be measured by the CSCI at the next inspection. Edge Leigh F56 F06 S25471 Edge Leigh V224960 060505 Stage 4.doc Version 1.30 Page 19 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 x 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 1 14 1 15 2
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 1 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 1 1 x x x x x x x x Edge Leigh F56 F06 S25471 Edge Leigh V224960 060505 Stage 4.doc Version 1.30 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 1 Regulation 5 Requirement A service user guide must be in place and given to each service user. (Timescale of 15th December 2005 not met) Each service user must receive a copy of their terms and conditions which includes the fees payable and method of payment (Timescale of 30th November 2005 not met) The drugs cabinet must be locked when left unattended. Care plans must be completed in sufficient detail to enable staff to monitor the progress of specific needs. The residents identified with a weight loss must be referred to their GP or dietician for advice on how to make for proper provision of their health. Care staff must be involved in care plans/care files, in order that they remain up to date on information regarding meeting a residents needs. Staff must receive training and guidance on how to maintain and promote a residents dignity. A strutured programme of social activities must be planned and
F56 F06 S25471 Edge Leigh V224960 060505 Stage 4.doc Timescale for action 15th June 2005 15th June 2005 2. 2 5 3. 4. 9 7 13 15 6th May 2005 15th June 2005 15th June 2005 5. 8 12 6. 7 12 30th June 2005 7. 8. 10 12 12 16 30th June 2005 30th June
Page 21 Edge Leigh Version 1.30 9. 10. 15 15 17 12 11. 15 12 & 18 delivered in a manner suitable to meet the needs of older people and those with dementia. Additionally, actitivities must be drawn up in consultation with the known interests of residents through the use of the care file, and consulting residents/family/friends. The menu must include the food served at breakfast. Residents at the home must be offered a choice of a substantive meal, if the choice made available to them is disliked or they are allergic etc Staff must receive training appropriate to the work they do in respect of care of people with dementia. 15th June 2005 6th May 2005 15th July 2005 12. 13. 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 15 Good Practice Recommendations A system must be in place for ensuring that staff offer all residents a hot choice of food at each meal. For residents with dementia who are unable to make known such a choice, arrangements should be in place for sufficient of each meal choice to be made, and for residents to indicate their choice visually. Adapted crockery and cutlery should be purchased including crockery which has heat retaining capacity. Consideration should be given to implementing a system that ensures jugs of juice are refreshed throughout the day. 2. 3. 4. 15 15 Edge Leigh F56 F06 S25471 Edge Leigh V224960 060505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Turton Suite, Paragon Business Park, Chorley New Road, Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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