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Inspection on 27/06/05 for Four Seasons Care Centre

Also see our care home review for Four Seasons Care Centre for more information

This inspection was carried out on 27th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a good service to the residents and although their mental capacity is limited it was evident from their body language and conversation that they were happy and well cared for. A partial tour of the home showed that it was clean and tidy. It is a well managed home with the constant support from the providers and the manager. The majority of the staff employed in the home have worked there for a considerable length of time. They are a well-informed, trained team of staff. Meals are varied and choices and alternative foods are available. The residents enjoy home cooked foods and they were complimentary about the quality of foods served.

What has improved since the last inspection?

This is the homes first inspection, which is still undergoing the transitional phase. However the business plan includes refurbishment within the home and further development of a second building on site. This is due to start in August 2005 and completion is planned for March 2006.

What the care home could do better:

At this time I feel the home requires a "settling in period" to allow staff to become familiar with the company policies and procedures. I am satisfied that the refurbishment will make a dramatic improvement to the environment and make life more pleasurable for the residents.

CARE HOMES FOR OLDER PEOPLE Four Seasons Care Home Ox Close Saltburn-by-Sea TS12 1NR Lead Inspector Lyn Burrell Unannounced 27 June 2005 10:00 am 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. Four Seasons Care Home B51-B01 SN63463 FourSeasons VN235244 270605 Stage 4.doc Version 1.40 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 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) Ltd Mrs Karen Thompson Care Home 30 Category(ies) of DE Dementia - 65 years and over (30) registration, with number of places Four Seasons Care Home B51-B01 SN63463 FourSeasons VN235244 270605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 1st inspection since registration 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 after the home was purchased from Highfield Group. The home provides nursing care for up to 30 residents suffering with dementia. The 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 straight forward. Four Seasons Care Home B51-B01 SN63463 FourSeasons VN235244 270605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of the home since it was registered in April 2005. There were two inspectors and the inspection lasted 3 hours. The manager and most of the staff have remained the same since the company takeover. This has been beneficial as there has not been any unnecessary changes for the residents to cope with. Many of the systems in the home have been in place for quite sometime and the management team have amended them accordingly. This inspection showed that the standards looked at during the inspection were mostly met. What the service does well: What has improved since the last inspection? This is the homes first inspection, which is still undergoing the transitional phase. However the business plan includes refurbishment within the home and further development of a second building on site. This is due to start in August 2005 and completion is planned for March 2006. Four Seasons Care Home B51-B01 SN63463 FourSeasons VN235244 270605 Stage 4.doc Version 1.40 Page 6 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. Four Seasons Care Home B51-B01 SN63463 FourSeasons VN235244 270605 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Four Seasons Care Home B51-B01 SN63463 FourSeasons VN235244 270605 Stage 4.doc Version 1.40 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 standard(s) 2,6 The residents or their relatives are given a copy of the terms of residency and the service user guide on admission to the home. This home does not provide intermediate care. EVIDENCE: The terms and conditions of residency are clear and concise and meet the requirements of the National Minimum Standards. At the time the contract is issued a copy of the service user guide is also given. This information is given to the resident or their relative depending on their mental capacity. Four Seasons Care Home B51-B01 SN63463 FourSeasons VN235244 270605 Stage 4.doc Version 1.40 Page 9 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) 7,8,9 There is a clear care planning system in place but there are gaps and omissions evident. The care plans do not reflect the current health needs of the residents care in the records we looked at. The system for handling and administration of medication is good but the disposal of medication needs further development. EVIDENCE: The care records that were looked at did not have risk assessments signed by the care manager or show evidence of a multi-disciplinary discussion to act in the best interest of the resident. Residents or their relatives must be included in planning care to ensure needs are fully met. The relative should sign the care plan to agree with the aims of the care if the resident does not have the mental capacity to make an informed decision. Care records were incomplete after a period of 11 days since admission to the home. Four Seasons Care Home B51-B01 SN63463 FourSeasons VN235244 270605 Stage 4.doc Version 1.40 Page 10 The medication system is satisfactory and a registered nurse is responsible for the ordering and administration of the medication. Since the environments agency has stated that care homes cannot return medication to their pharmacy, the home manager has developed a policy for managing hazardous waste. The company who removes clinical waste has arranged for the home to have a sealed bin with a solution in it to denature the medicaments. However to denature drugs on site a license from the Environments Agency is required and to date only hospitals are able to apply for a denaturing license. Four Seasons Care Home B51-B01 SN63463 FourSeasons VN235244 270605 Stage 4.doc Version 1.40 Page 11 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) 15 The meals offered to the residents were good offering both choice and variety and also catering for special dietary needs. EVIDENCE: The menus were clear and were rotated 4-weekly. The chef speaks to residents prior to each meal to ask what their preference is. The chef also has a list of residents likes and dislikes in the kitchen to ensure the resident receives a meal that they will eat. The meals meet the government guidance of all residents receiving the 5 portions of fruit and vegetables per day. Extra fluids are given in the hot weather to prevent people from becoming dehydrated. The dining room was clean and an attractive place for residents to eat their meals. Four Seasons Care Home B51-B01 SN63463 FourSeasons VN235244 270605 Stage 4.doc Version 1.40 Page 12 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 home has a satisfactory complaints system in place. The home has an adequate system in place to ensure residents are protected from abuse. EVIDENCE: The home has a detailed complaints procedure and supporting records. There have not been any complaints about this home in the last 6 months. Residents are protected from abuse, the staff have received training in adult protection and they are aware of the procedure to follow if an abusive situation was suspected. The induction programme informs staff about recognising abuse and further training is undertaken at a later date. Staff recruitment records show there is a completed application form; CRB checks and 2 references are sought. Four Seasons Care Home B51-B01 SN63463 FourSeasons VN235244 270605 Stage 4.doc Version 1.40 Page 13 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) 19,22,26 The standard for the environment within the home is fairly good, there are plans underway to improve the home in the near future. A range of specialist equipment is available for residents use in order to improve their independence. The home was clean but odorous in places. EVIDENCE: The building is in good order and there are plans for structural changes to take place in the near future. A new kitchen has been ordered and it is anticipated this will be fitted around September 2005. There are two mobile hoists in the home and the baths have a swing seat to enable safer bathing. However the bath seats require the holes to be plugged as it may cause discomfort to the residents without them. The home was clean and tidy throughout though several places were extremely odorous. Four Seasons Care Home B51-B01 SN63463 FourSeasons VN235244 270605 Stage 4.doc Version 1.40 Page 14 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) 27,29,30 The staffing levels are more than adequate and offer consistent care within the home. The standard of recruitment and vetting practises of staff remain good with all of the appropriate checks being carried out. The arrangement for staff training and induction demonstrates a clear understanding for preparing staff to work with this client group. EVIDENCE: Duty rotas show there is a registered nurse on duty supported by 5 carers during the day and 3 carers at night. Staff are consistent and were seen to treat the residents kindly and with respect. There are 30 residents currently living in the home the majority requiring care for medium dependency. It would be good practise to implement a dependency scoring system, this will allow staffing levels to change in line with the needs of the residents. The staff records show that the staff had had all of the recruitment checks completed in line with the company policy. Records are clear and concise. The training plan was looked at and it is evident that the staff have regular training in health and safety issues and care practises. Policies and procedures are up to date. Four Seasons Care Home B51-B01 SN63463 FourSeasons VN235244 270605 Stage 4.doc Version 1.40 Page 15 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) 36,38 Staff receive regular supervision in line with the National Minimum Standards. The home has systems in place to ensure health and safety of the staff and residents. EVIDENCE: There were certificates of maintenance in place and up to date that showed the equipment used in the home was safe and in good working order. Policies are also available to advise staff of how to deal with a safety issue at any time. Regular fire drills take place that include staff and residents. Staff records show regular supervision on a 1:1 basis takes place. Four Seasons Care Home B51-B01 SN63463 FourSeasons VN235244 270605 Stage 4.doc Version 1.40 Page 16 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 3 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x 2 x x x 2 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 Standard No 16 17 18 Score 3 x 3 x x x x x 3 x 3 Four Seasons Care Home B51-B01 SN63463 FourSeasons VN235244 270605 Stage 4.doc Version 1.40 Page 17 no Are there any outstanding requirements from the last inspection? 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 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. The home must be free from unpleasant odours. Timescale for action 31/07/05 2. 9 13,15,17, 18 31/07/05 3. 4. 22 26 4,23 6,23,27 31/07/05 31/07/05 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 Good Practice Recommendations Four Seasons Care Home B51-B01 SN63463 FourSeasons VN235244 270605 Stage 4.doc Version 1.40 Page 18 Commission for Social Care Inspection Unit 1, 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 © 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 Four Seasons Care Home B51-B01 SN63463 FourSeasons VN235244 270605 Stage 4.doc Version 1.40 Page 19 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!