CARE HOMES FOR OLDER PEOPLE
Four Seasons Care Home Ox Close Saltburn-by-Sea TS12 1NR Lead Inspector
Lyn Burrell Unannounced Inspection 18th November 2005 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 Four Seasons Care Home DS0000063463.V266289.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. Four Seasons Care Home DS0000063463.V266289.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Four Seasons Care Home Address Ox Close Saltburn-by-Sea TS12 1NR 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) 01287 624516 01287 624008 Key Healthcare (Operations) Limited Mrs Karen Thompson Care Home 30 Category(ies) of Dementia (30) registration, with number of places Four Seasons Care Home DS0000063463.V266289.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 27th June 2005 Brief Description of the Service: Four Seasons Care Centre has been operational as a Care Home since 1989. In April 2005 Key Healthcare Ltd became the Registered Provider. The home provides nursing care for up to 30 residents suffering with dementia and mental disorder. The home has two floors with lift access, rooms are all single and there are no en-suite facilities. Registered Mental Health Nurses are on duty at all times supported with care staff. The home is situated on the edge of Saltburn through access to the shops and the beach is straightforward and a bus route and railway station are close by. Four Seasons Care Home DS0000063463.V266289.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A positive inspection, whereby most of the National Minimum Standards inspected was met. The inspection lasted three and a half hours with one inspector. There were many residents who engaged in discussion with the inspector and others were given the opportunity to participate. However four residents and three relatives had an in-depth discussion about the service that was offered in the home. During this inspection discussion with residents took place, the inspector walked around the home, care records, medication policy, activities, residents legal rights, personal monies and staff supervision. A tour of the home showed that it was clean, tidy and well decorated throughout. What the service does well: What has improved since the last inspection?
Four Seasons Care Home DS0000063463.V266289.R01.S.doc Version 5.0 Page 6 The management team have continued with their refurbishment programme and a new carpet has been fitted in some bedrooms and other areas have been redecorated. The new building is underway and the foundations are complete, it is likely that the building will be completed in the spring of 2006. What they could do better:
It was noted that the registration certificate did not reflect all of the clients living in the home. There are 11 people living in the home with a mental disorder and 19 people suffering with dementia. Two residents are under the age of 65 and a variation of age is required. Three of the four outstanding issues from the last inspection have not been addressed. It was identified at the last inspection that care plans must be an agreed contract of care. The resident or their representative should sign to agree to the prescribed care. A policy must be developed for the disposal of medication in keeping with the Environment Agency Regulations. The bath seats must have plugs fitted to prevent injury from occurring to the resident. Review the quality assurance programme and include relatives and other healthcare professionals. Arrange meetings with residents and families periodically to listen to their views about the service they receive. Relatives said: “I worry about my relative and he must be kept safe” “ It is difficult to find staff at times” “ At the end of the day the home can be odourus” “The staff in the last home were more approachable” “A male member of staff can be brusque at times to the residents”. Four Seasons Care Home DS0000063463.V266289.R01.S.doc Version 5.0 Page 7 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. Four Seasons Care Home DS0000063463.V266289.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Four Seasons Care Home DS0000063463.V266289.R01.S.doc Version 5.0 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 the following standard(s): 1,3 The Statement of Purpose does not reflect the current client group living in the home. Each service user’s needs are assessed prior to their move into the home and periodically thereafter. This will help ensure that each service user’s needs are met at the home and inappropriate admissions avoided. EVIDENCE: The Statement of Purpose needs to be developed to include the range of conditions and the ages of the residents who live there. The current registration states the home can admit up to 30 people suffering with dementia who are over the age of 65 years. There are currently eleven people living in the home with mental disorder and two residents are under the age of 65 years. The provider has agreed to vary the registration and the application form has been sent to the head office for completion. Four Seasons Care Home DS0000063463.V266289.R01.S.doc Version 5.0 Page 10 When the home is contacted regarding a place in the home the staff complete an enquiry form taking the persons details. Should a place be available and the person has the appropriate needs to be cared for in Four Seasons, the manager will visit the prospective client to gather detailed information. The manager or representative from the home, who are Registered Nurses, uses the information and risk assessments to ensure the appropriate level of care is provided and minimises the risks of harm to the person. This information is reviewed after 6 weeks and involves the resident, family, care staff and social worker. Four Seasons Care Home DS0000063463.V266289.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9,10 The health and personal care needs recorded in the care plans reflect the resident’s current level of need. As such the resident’s welfare is promoted and safeguarded. Medication administration procedures generally ensure that the resident’s health care needs are addressed. However, some improvement needs to be made in this area. Staff at the home support residents with their social, health and personal care needs in a way that treats them with respect and promotes their rights and privacy. EVIDENCE: The care plans that were looked at were detailed and contained valid information about the person’s life history. This information is paramount for the development of the care to allow it to be tailored to the individuals needs. Four Seasons Care Home DS0000063463.V266289.R01.S.doc Version 5.0 Page 12 The care plans were realistic and easy to read, they described a persons needs fully and reviewed them monthly to observe for changes in the persons well being. The medication policy needs to be developed to include the Environment Agency regulation with regard to the disposal of unused medication. Pharmaceuticals cannot be returned directly to the chemist and must be disposed of as hazardous waste. Through observation and discussion with residents and staff it was evident that the resident’s were treated with dignity and respect. Staff spoke kindly to the resident’s and were seen to be patient when assisting someone. Four Seasons Care Home DS0000063463.V266289.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 Residents are offered the opportunity of participating in a wide range of leisure and social activities enabling them to lead active and fulfilled lives. Social activities both in and outside of the home are well-managed enabling service users to make positive choices about how they spend their day and friends and families are very much a part of this process. EVIDENCE: There is an activities person employed in the home, the notice board informs people of forthcoming events and places to visit. Photographs are displayed to show visitors and residents what has taken place in the home and what people have enjoyed participating in. Activities planned for November include an auction, making Christmas cards, visits to the Cheshire Home for coffee and bingo, going to the theatre, visiting entertainers and a Christmas party. Families are free to visit at any reasonable time; relatives confirmed this during our discussion. Four Seasons Care Home DS0000063463.V266289.R01.S.doc Version 5.0 Page 14 Residents said they were able to choose what they wanted to do and when. If assistance was needed for a resident the staff said they would contact the advocacy service or the resident’s social worker. Four Seasons Care Home DS0000063463.V266289.R01.S.doc Version 5.0 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 Robust procedures are also in place, which ensure that resident’s legal rights are protected. EVIDENCE: To ensure resident’s rights are protected some residents have correspondence with the court of protection to act in their best interest. There are equally some relatives who have power of attorney to protect their family member and act on their behalf for decision making. Ballot box voting is also available for the residents use for local and general elections and the advocacy service is available via the Citizens Advice Bureau. Four Seasons Care Home DS0000063463.V266289.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): This standard was not assessed on this occasion. EVIDENCE: Four Seasons Care Home DS0000063463.V266289.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): This standard was not assessed on this occasion. EVIDENCE: Four Seasons Care Home DS0000063463.V266289.R01.S.doc Version 5.0 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 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): 33,35,36 Views of the residents are not sought to allow them to contribute to the development of the service. Staff are appropriately supervised which assists in promoting and safeguarding the best interests of the resident’s. An arrangement for the handling of service users’ personal savings serves their interests. EVIDENCE: A recent quality survey with regard to the standard of care offered in the home only had three responses. However it would be beneficial to include other healthcare professionals who visit the home, the residents and their relatives.
Four Seasons Care Home DS0000063463.V266289.R01.S.doc Version 5.0 Page 19 This would create a total picture of the service and areas that could be developed. Computer generated financial records clearly show each transaction and displays a running total of the residents balance. Receipts are also kept as proof of purchase. Staff have regular supervision from an appointed supervisor, the records were up to date and supervision of staff happened every two months. Four Seasons Care Home DS0000063463.V266289.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME 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 2 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 3 X X Four Seasons Care Home DS0000063463.V266289.R01.S.doc Version 5.0 Page 21 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 7,8 Regulation 13,15,17, 18 Requirement Care records must be completed and signed appropriately and they are required to be in keeping with the Nursing & Midwifery standard for record keeping as well as the Care Homes Regulations 2001 The registration certificate must reflect the health status of the residents. The Statement of Purpose must be amended to reflect the client group and their ages that can be admitted to the home. Medications must be disposed of in accordance with the Environments Agency Regulations and the Care Homes regulations 2001 Bath seats must have plugs fitted to prevent injury to the resident. Residents’ opinions must be sought about the service that is offered in the home. Timescale for action 31/12/05 2 3 1 1 4 4,5 31/12/05 31/12/05 4 8,9 13,15,17, 18 31/12/05 5 6 22 33 4,23 24,25,26 31/12/05 31/12/05 Four Seasons Care Home DS0000063463.V266289.R01.S.doc Version 5.0 Page 22 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 Four Seasons Care Home DS0000063463.V266289.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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