Inspection on 26/07/07 for Four Seasons

This inspection was carried out on 26th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Four Seasons 10/01/07

Four Seasons 13/06/06

Four Seasons 02/02/06

Four Seasons 16/11/05

Four Seasons 06/01/05

Four Seasons 14/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Four Seasons 81 Halifax Road Littleborough Lancashire OL15 0HL Lead Inspector Bernard Tracey Unannounced Inspection 26th July 2007 09:15a 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 Four Seasons DS0000025472.V343925.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. Four Seasons DS0000025472.V343925.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Four Seasons Address 81 Halifax Road Littleborough Lancashire OL15 0HL 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) 01706 376809 F/P 01706 376809 Mrs Wendy Collinson Mrs Wendy Collinson Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Four Seasons DS0000025472.V343925.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home is registered for a maximum of 16 service users to include: up to 16 service users in the category of OP (Older People) The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. Schedule of accommodation must not be varied without written consent. 10th January 2007 Date of last inspection Brief Description of the Service: Four Seasons is a large detached house which, over the years, has been extended to offer personal care and accommodation to 16 service users over the age of 65 years. Nursing care is not provided. Accommodation is in 16 single rooms, with 12 rooms having en-suite toilet facilities. The home is located on the main A58 Halifax - Rochdale Road, approximately half a mile from Littleborough centre where a variety of shops and other facilities are located. Transport links are good, with a main bus route passing close to the home. A train station is located in Littleborough. The front door is accessed down three steps, ramped access is provided to the rear of the building. Parking is available on the main road across from the home and a small area is also located to the rear of the property. There are garden areas to the front and rear of the home. The home is owned and managed by Mrs Wendy Collinson. At the time of this inspection weekly fees were £365. Additional charges were for dry-cleaning, private chiropody and private telephone calls. Four Seasons DS0000025472.V343925.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The manager of the home was not made aware that this site visit (part of a key inspection) was going to take place. Several weeks before the inspection questionnaires were sent out to doctors, social workers and district nurses, as well as to the residents of the home and their relatives. The questionnaires asked what people thought of the care and services provided by the home. The manager of the home was also asked to fill in a questionnaire, which we were able to use to look at how the home was developing and help us to plan our site visit. The inspector spent 4.45 hours at the home. During this time he looked at care and medicine records to ensure that health and care needs were met and also studied how information was given to people before they decided to move into the home. A tour of the building was undertaken and time was spent looking at records regarding safety in the home. He also examined files that contained information about how the staff were recruited for their jobs, as well as records about staff training. The Inspector spent time speaking to six residents, as well as speaking to two relatives, four staff and the manager. What the service does well: Four Seasons has very good admission procedures, which include a detailed assessment process that fully identifies the needs of new residents. Care planning and the standard of actual care delivery are also very good, as are the arrangements for accessing healthcare services. The home is well staffed by a dedicated and skilled team, who provide a stimulating and cheerful atmosphere for residents. There are good resources for residents to enjoy a variety of activities and occupation. Residents’ wishes are taken into account when planning their care and staff show respect for residents’ choices. The cook is fully aware of residents’ dietary needs and serves good quality meals, which residents enjoy. Both residents and staff benefit from the home’s strong leadership and open management ethos. Returned surveys sent out prior to the site visit include these comments from relatives: “A quite excellent care home” “A wonderful set of carers in an exemplary home” Four Seasons DS0000025472.V343925.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Four Seasons DS0000025472.V343925.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 Four Seasons DS0000025472.V343925.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) Quality in this outcome area is good. Detailed assessments are undertaken before people come into to the home so they can feel confident that their needs can be met. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The admission arrangements for new residents were very thorough. This ensured that the home would be a suitable placement for that person and would be able to meet their assessed needs. Four Seasons DS0000025472.V343925.R01.S.doc Version 5.2 Page 9 Initial enquiries were recorded and followed up by a visit to the individual, either in their own home or, more commonly, in hospital, to complete a detailed assessment of their needs. The manager liaises closely with family members and any health care professionals involved with the prospective resident. This helped the manager to build up a full picture of the person’s needs. The assessment included personal and healthcare needs, as well as social care and behavioural needs. The manager generally conducted preadmission assessments. All residents had a contract in their personal file, either signed by the individual or, in some cases, their representative. Four Seasons DS0000025472.V343925.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. Care practices ensured that the residents health care needs were met, that they were treated with respect and their dignity was upheld. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Each resident had a detailed up to date and individual plan of care, covering all aspects of personal, health and social care needs. These are based on the preadmission assessment and other specialist assessments in place, including social work assessments. The care files of three residents were looked at. Each of these files contained a detailed and comprehensive care needs assessment that describes the help that the resident needs with everyday living, including health, personal and social care needs. All of these documents had been reviewed at monthly intervals using a separate document that described any changes in the way that the resident needed to be looked after. Four Seasons DS0000025472.V343925.R01.S.doc Version 5.2 Page 11 Any areas of risk for the resident were highlighted along with the planned action to reduce that risk. These included an up to date manual handling assessment and a nutritional assessment tool that is used at the time of the resident’s admission to the home and then afterwards as required. Nutritional wellbeing is also assessed by direct observation and by regular and up to date weight checks. Skin condition is also checked by direct observation with a pressure area care plan being implemented if required. Care plans demonstrated that residents’ personal choices and preferences had been taken into account by staff around care delivery, such as who liked a bath and who would prefer a shower. Personal care was provided privately in bedrooms or bathrooms and door locks or engaged signs were used. One resident wrote to us to say “Very good indeed. Always there when needed. All staff very pleasant supportive and helpful”. Residents wore their own clothes and were dressed appropriately for the weather and their activity. Hair care, nail and teeth care, and shaving had been attended to. Healthcare arrangements were also good. Residents had good access to their local doctor and the district nursing service visited the home regularly. The management of medicines in the home was safe and served to protect residents from harm and ensure they benefited from the medicines prescribed for them. Staff were knowledgeable about residents’ medicines and understood about monitoring for side effects and adverse reactions. Medicine records were good, although there was evidence that hand written medications had not been checked by two members of staff, in line with good practice recommendations. Staff who have responsibility for giving out medicines have been given the necessary training for this task, which was updated in 2006. The home has a satisfactory medicines policy and procedure that includes guidance for the selfadministration of medicines. No residents were dealing with their own medicines at the time of this visit. Residents spoken with were all complimentary about how staff assisted them with personal care tasks and felt their privacy and dignity were respected at all times. This was also observed during the inspection. The care assistants interviewed were able to give good examples of how they promoted privacy and dignity in their daily care routines, for example, knocking on bedroom doors before entering. The residents said that the staff had a “kind and considerate” manner and that the staff spoke to them in a “civil and courteous” way. Four Seasons DS0000025472.V343925.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. Residents benefit from a range of social activities and are able to exercise choice over their daily lives. The home is run for the benefit of residents and the provision of meals is good. This judgement has been made using the available evidence, including a visit to the service. EVIDENCE: The residents’ social and recreational preferences are recorded in their care plans and a record is made of the activities that they have joined in with. Residents’ ability to exercise choice and control over their lives were documented. Where preferences were known, staff abided by these. In other cases, staff observed residents’ reactions closely to judge whether they liked something or not and this information was recorded in their care plan and passed on to other staff. Four Seasons DS0000025472.V343925.R01.S.doc Version 5.2 Page 13 The home operated an open visiting policy, meaning residents could have visitors at any time suitable to them. Visitors had to gain entry and exit to the home via staff, as the doors were secured with keypad locks. Visitors confimed that they were made welcome in the home. The residents are able to bring personal items in to the home, such as televisions, radios, photographs, pictures and ornaments. All of the bedrooms visited were highly personalised and provided a comfortable environment for the residents. The menus showed a good variety of foods and the quality of meals served was good. Where residents’ preferences or special dietary needs were known, and listed in the kitchen, alternatives were automatically prepared. There was a high staff presence at meal times to assist and observe residents. Weight records showed residents to be well nourished and those people identified as needing assistance had additional support and monitoring. Four Seasons DS0000025472.V343925.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. There is a clear complaints procedure and residents and their families know action will be taken to resolve their concerns. Staff have a good knowledge and understanding of Adult Protection issues which safeguards residents from abuse. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: There is a clear complaints procedure, which told people how and who to make any complaint to. The procedure was well advertised to relatives and visitors to the home. Records showed that any complaints made had been fully investigated and responded to appropriately. A staff member said, “If a resident wanted to make a complaint, I would go to the manager and give her the information”. There was also evidence that, where relevant, the manager made complaints on behalf of residents who received a poor service outside of the home. No complaints have been made directly to the Commission for Social Care Inspection. Four Seasons DS0000025472.V343925.R01.S.doc Version 5.2 Page 15 All staff have undertaken training in relation to the Protection of Vulnerable Adults. The home also has an abuse policy and whistle blowing procedure. The staff training record evidenced abuse awareness training for a number of staff and staff interviewed had an understanding of how to report an alleged incident. The home has a copy of the Rochdale Guide for the Protection of Vulnerable Adults. Four Seasons DS0000025472.V343925.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 excellent. The home is clean, safe and well maintained, and provides a high quality living environment for the residents. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Residents are encouraged to see the home as their own. It is a very well maintained, attractive home and has very good access to community facilities and services. It has a wide range of up to date specialist equipment and adaptations to meet the individual needs of people who use the service. Four Seasons DS0000025472.V343925.R01.S.doc Version 5.2 Page 17 The home is purpose built and accommodation is provided on two levels. It is fully accessible to people who are physically disabled and is fitted with aids and adaptations to promote independence. The main entrance hall is spacious and there is ample information available regarding the home and the service it provides. The home is well maintained, decorated to a high standard and was clean and tidy during the site visit. A partial tour of the building was undertaken, two bathrooms, a shower room and six bedrooms were viewed. The bathrooms were clean and tidy and hot water temperatures are recorded each month to ensure the hot water is delivered to a safe temperature. Bedrooms viewed had individual items and were homely. A resident said, “I have everything I need, including some of my own furniture. The manager also arranged for my telephone to be installed”. Bedrooms have door locks and storage space for valuable items. have a call system with a hand held buzzer to call for assistance. Bedrooms The home is equipped with comfortable furniture, fittings and electrical equipment, including television and CD players. . The home has a well equipped laundry and there was evidence of gloves and aprons for staff use. Infection control training is given to staff and infection control policies are available. Residents commented on the good laundry. Residents say that there is always plenty of hot water and the temperature in the home can be changed to meet their personal choice, especially in their own rooms. The home is always very well lit, clean and tidy and smells fresh. Residents’ individual rooms are light and spacious and those seen showed a good level of personalisation with furniture and memorabilia. The home provides a well maintained, clean, comfortable and attractive home in which to live and which meets all the assessed needs of the residents. Bedrooms are well planned with some having en-suite toilet and/or shower facilities. The home has appropriate aids and equipment, such as assisted bathing facilities, handrails and a passenger lift in place. The home employs sufficient domestic staff and on the day of this visit the home was clean, fresh and hygienic. Policies and procedures are in place to promote a high standard of cleanliness and hygiene. Four Seasons DS0000025472.V343925.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 good. There are appropriately trained and experienced care staff employed so that residents feel supported and that their needs are understood and met. The home’s recruitment policy is generally robust to protect the residents. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The owner/manager had provided details of the staffing arrangements in the home prior to the inspection, the details of which were checked during the visit. Staffing levels within the home were seen to meet the needs of residents. Care staff that undertook their duties in a friendly and caring manner, promptly supported residents’ needs. Residents confirmed that staff were always respectful and met their needs competently. In the main, residents were satisfied with the support they were given and described staff as “ok”, “nice people”, “alright”, “find time to listen” and “good”. Four Seasons DS0000025472.V343925.R01.S.doc Version 5.2 Page 19 Sufficient ancillary staff were employed, e.g., domestics, laundry and kitchen assistants, cook and handyman. Staff were, in the main, knowledgeable about the needs of residents and demonstrated that they understood their own role. Staff files demonstrated that a robust recruitment process is in place, with all appropriate checks being undertaken. These include references, Criminal Record Bureau disclosures, application forms and references with one from the previous employer always obtained. New staff undertake a full induction programme that is followed by further inhouse training. Several staff are presently undertaking National Vocational Qualifications in care at Level 2. The home has an ongoing training programme that staff can apply for. Since the last inspection several staff have received training in abuse awareness and more are booked to attend in the future. Staff spoken with showed that their knowledge had increased since the training and that they were more aware and confident in reporting concerns. Four Seasons DS0000025472.V343925.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, 36 & 38 Quality in this outcome area is good. The home is well managed and run in the best interests of the residents. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Throughout the inspection the inspector was able to evidence the professional, capable and approachable manner in which the manager undertook her role when dealing with residents, staff and visitors. Four Seasons DS0000025472.V343925.R01.S.doc Version 5.2 Page 21 Staff and residents said she was easily accessible and welcomed her ‘open door’ policy, as well as providing structure and a sense of direction through more formal meetings. Residents said she made sure she spoke to them on her arrival at the home each day to check out how they were feeling. The manager, who is also the owner of the home, operates a quality assurance programme made up of audits and satisfaction surveys to gain feedback on the quality of the service offered at the home. The responses to the latest survey had not been collated as yet but showed that respondents were very happy with the care provided but would like to see the fabric of the home upgraded. The manager also hosts a relatives’ group, which meets quarterly, and enables relatives to make their views known. A set of management audits was used to monitor the standard of care planning, medication records, upkeep of the building and provision of meals. The manager also sees every accident/incident report and is therefore able to implement any newly identified safety measures accordingly. The home holds small amounts of spending money of behalf of some residents. Any spending was accounted for with receipts and the records were open to scrutiny by residents or their advocates. The home had sound systems in place for promoting the health, safety and welfare of staff and residents. All services and equipment for the building were under contract for regular testing and repair and the appropriate documentation to support this was available for examination. There was information on, and staff had received training in, fire safety, safe moving and handling, and the safe use of chemicals, food hygiene and first aid. Four Seasons DS0000025472.V343925.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 N/A 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 Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Four Seasons DS0000025472.V343925.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 2 Refer to Standard OP8 OP9 Good Practice Recommendations Daily notes made in the residents’ care plans should be timed as well as dated. Hand transcribed medications should be signed by two staff members in order to avoid errors. 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