CARE HOMES FOR OLDER PEOPLE
Four Winds Residential Home Elwick Road Hartlepool TS26 0DD Lead Inspector
Mr Stephen Ellis Unannounced Inspection 17th November 2006 2:00 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 Winds Residential Home DS0000045233.V317988.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 Winds Residential Home DS0000045233.V317988.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Four Winds Residential Home Address Elwick Road Hartlepool TS26 0DD 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) 01429 869019 01429 233715 Mr Matt Matharu Sally Anne Sharples Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Four Winds Residential Home DS0000045233.V317988.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One named individual who is in the category (MD) mental disorder is allowed to reside in the home. 16th January 2006 Date of last inspection Brief Description of the Service: Four Winds is a care home for older people who require personal care. The home is situated in its own grounds in a residential area close to Ward Jackson park in Hartlepool. The home is a large converted house, which has been extended to give 18 single bedrooms (10 with en suite toilet and wash hand basin) and two double bedrooms for those who choose to share (both with en suite facilities). A passenger lift connects both floors. The home provides lounge and dining facilities for residents’ use. Car parking is available at the front of the building. There is a patio area and landscaped garden to the rear. The weekly charge is £354, although the amount service users pay depends on their personal circumstances. They may also be required to pay a contribution towards the costs associated with voluntary activities. For example, hairdressing is available, with costs varying between £3 and £15, and chiropody at £10. Four Winds Residential Home DS0000045233.V317988.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 4.5 hours. It included a tour of the building, examination of a number of records and discussions with 14 residents, one relative and 5 staff. Comments were also received from 3 relatives/visitors to the home via questionnaires and 2 service users via questionnaires. The overall quality rating for this care home is: ‘good’. This judgment has been made from evidence gathered both during and before the visit to this service. What the service does well: What has improved since the last inspection?
The home’s statement of purpose has been updated. Care plans are being reviewed at least monthly. Written risk assessments are being done where
Four Winds Residential Home DS0000045233.V317988.R01.S.doc Version 5.2 Page 6 necessary. The practice of ‘putting up’ (or re-dispensing) medicines in advance of their administration has stopped. Photographs of each resident have been placed in the Medicines Administration Record, to aid identification. A risk assessment tool for pressure sores and other, preventative measures are used (in conjunction with Community Nursing services) where residents may be at risk. The majority of the registered manager’s hours (60 ) are now supernumerary (that is, not counted towards the direct care hours provided ‘on the floor’). Remedial work in the kitchen has been completed. Reports of monthly regulation 26 visits to the home, carried out by the registered provider’s representative, are completed and available for inspection at the home. 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 Winds Residential Home DS0000045233.V317988.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 Winds Residential Home DS0000045233.V317988.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): 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives have the information needed to choose a home that will meet their needs. They have their needs assessed and a contract which tells them about the service they will receive. EVIDENCE: Comments received from residents and relatives confirmed that full assessments of needs were carried out prior to admission to the home. They said there was enough information from which to make a choice about being admitted. A statement of purpose and statements of terms and conditions of residence are supplied routinely. These are helpful documents and the content is generally good, but some further detail is required. For example, in the home’s terms and conditions of residence/contract, the information about fees
Four Winds Residential Home DS0000045233.V317988.R01.S.doc Version 5.2 Page 9 and complaints needs to be elaborated further, giving timescales for complaint investigation and conditions under which fees may be refunded, in line with regulations. The legislation quoted needs to be checked and amended where necessary. A separate service user’s guide needs to be provided, including all of the items referred to in regulation 5 of the care Homes Regulations 2001. This should be made available to every service user and prospective service user. Care plans revealed comprehensive, detailed assessments of need being carried out both prior to admission and afterwards, as confirmed by members of staff. These assessments showed that the home only admitted people whose assessed needs it could meet. Four Winds Residential Home DS0000045233.V317988.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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care, which a resident receives, is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Residents said that they believed their health and social care needs were well known by staff and were being fully met. They said that the community nurse or doctor would see them whenever required. Their personal and social care needs were known, understood and respected by the staff team. They said that they felt they were treated with respect and sensitivity. As one resident said: “I am very happy here and very well looked after”. Another said “My healthcare needs are well attended to”. A typical comment from a relative was: “The staff and accommodation are both excellent and I am very grateful for all the care, help and support we have received”.
Four Winds Residential Home DS0000045233.V317988.R01.S.doc Version 5.2 Page 11 Care plans were detailed and comprehensive about service users’ health and social care needs, providing clear guidance to staff. They were subject to regular review, in keeping with National Minimum Standards. Staff training in Care (for example, National Vocational Qualifications (NVQ) at level 2 and above) has included the important issues of privacy and dignity and a high percentage of care staff (over 80 ) have completed NVQ in care. There are good arrangements for the safe administration of medicines. All care staff members responsible for medicines have completed the Safe Handling of Medicines course. There is good support from local Pharmacists who supply most of the medication in bottles and boxes. There are good storage systems and care staff check all medication when it is received into the home. The home requires medication to be administered only from the container(s) into which the pharmacist dispensed it originally. Medication is kept securely in lockable cabinets and trolleys. Residents may attend to their own medication, but in practice most prefer to delegate this responsibility to staff. Unwanted medicines are returned promptly to the Pharmacist and the home is careful not to stockpile large quantities. Senior staff carry out medicine audits routinely. Four Winds Residential Home DS0000045233.V317988.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 – 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to choose their lifestyle, social activity and keep in contact with family and friends. Social, cultural and recreational activities meet residents’ expectations. Residents receive a healthy, varied diet according to their assessed requirement and choice. EVIDENCE: Residents said they enjoyed living at the home. Many commented on the good rapport with staff. As one resident said: “It is a very nice home. They take good care of us”. Another resident said “I can press the buzzer and they’re there straight away. The staff are very good”. Many said the staff members were kind and supportive and used words like “lovely” and “excellent” to describe them. Residents confirmed that they could choose how they spent their time in the home and were free not to join in activities and social events if they did not wish to. The programme of social and recreational activities included bingo, cards and dominoes, exercises, films and baking. There were also regular social events at the home involving residents, relatives and staff. The recent Halloween party held at the home had been well received. Two
Four Winds Residential Home DS0000045233.V317988.R01.S.doc Version 5.2 Page 13 members of care staff take responsibility for leading on social and recreational activities. Also, some residents go out with their relatives or friends, especially when the weather is good. Some residents preferred to spend their time reading or doing crossword puzzles. Others liked to watch television some of the time. As one resident said “You can please yourself about activities. For example, I like reading and TV, but I can go down into the lounge at any time…it’s a nice, easy atmosphere”. All residents described the catering as being good or very good. There was a good choice of menu and residents’ preferences were catered for wherever possible. Four Winds Residential Home DS0000045233.V317988.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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have access to a robust, effective complaints procedure and are protected from abuse. EVIDENCE: All residents and the one relative spoken to on the day said that they were confident about approaching staff and management about any concerns or complaints they might have. They described the staff and management as being very approachable, helpful and friendly. A written complaints procedure is provided in the statement of purpose. Staff and management are aware of the need to safeguard adults from abuse or neglect and most have undergone training in these issues. They are aware of the home’s ‘whistle blowing’ policy, which encourages staff to speak out about any suspected abuse. All staff members have had enhanced Criminal Records Bureau (CRB) checks and Protection of Vulnerable Adults (POVA) checks carried out as required by law. Also, two references are obtained in respect of each new employee, with special attention given to the last employment. This is to ensure that unsuitable people are not employed to care for vulnerable adults. New staff members go through induction and foundation training so that they have the right knowledge and skills to do their jobs competently. Four Winds Residential Home DS0000045233.V317988.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: There were no unpleasant odours and the home was found to be clean in all the areas inspected. Most care staff members have completed training in health and safety, fire safety, food hygiene and infection control. However, paper towels, as well as liquid soap, need to be provided in communal toilets and bathrooms in wall-mounted containers, to promote hygienic practices (although residents have personal flannels and towels in their rooms).
Four Winds Residential Home DS0000045233.V317988.R01.S.doc Version 5.2 Page 16 Residents said that they were pleased with the premises, finding them comfortable and homely as well as practical. They also described the home as being clean. The home is well maintained with repairs and servicing being carried out promptly and according to schedule. However, suitable locks still need to be fitted to bedroom doors in the interest of privacy, choice and dignity; one en suite toilet on the ground floor needs a call point to be fitted; and a second assisted bathing facility should be provided, ideally on the first floor, to complement the assisted bathroom on the ground floor. The current first floor bathroom does not permit assisted bathing. Alternatively, or in addition, a walk in, level entry shower should be considered, in the interests of service user choice and convenience. One service user had commented earlier in the year that he was disappointed in the lack of shower provision when he used the home for respite care. Four Winds Residential Home DS0000045233.V317988.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to fulfil the aims of the home and meet the changing needs of residents. EVIDENCE: On the day of inspection, there were 20 residents being accommodated. Residents said that they got on well with staff and felt that there were sufficient numbers of staff to meet their needs. This view was reflected in staff comments. Staff morale was reported to be good. During the day (7am to 10 pm) there are two care staff members on duty, one of whom is a senior. In addition, between 8 am and 1 pm, and between 4 pm and 8 pm, a third carer is deployed. At night, there are 2 care staff members on duty, one of whom is designated as being in charge. The manager and/or the deputy are on call at night. The home’s manager is full time, with 60 of her time being dedicated to management duties and 40 to care, when she works ‘on the floor’ providing direct care to residents. A senior Manager from within the group and the registered provider, Mr Matharu, provide management support. Catering and domestic hours are appropriate. A full staff training and development programme is in operation. Staff confirmed that they had undergone induction and foundation training. Thirteen
Four Winds Residential Home DS0000045233.V317988.R01.S.doc Version 5.2 Page 18 out of the 16 members of care staff had completed National Vocational Qualifications (NVQ) in care at level 2 or 3 (81 ), which is commendable. Staff also confirmed that they participate in regular supervision sessions, as recorded in individual staff files. Four Winds Residential Home DS0000045233.V317988.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. EVIDENCE: The registered manager is becoming increasingly experienced and competent in her new role, having worked at senior and deputy levels for many years. Residents and staff spoke well of her leadership skills and commitment to good outcomes for residents. She was described as being approachable and caring. She intends to register for the Registered Manager’s Award at NVQ level 4 in
Four Winds Residential Home DS0000045233.V317988.R01.S.doc Version 5.2 Page 20 the near future. She also intends to work towards her NVQ qualification in care at level 4, having previously achieved NVQ level 3 in care. Good accounting procedures are followed, with receipts and signatures being provided for all financial transactions involving residents’ personal monies, in which the home is involved, wherever practicable. Relatives look after the personal monies of many residents. In those situations where the home helps look after residents’ monies, such as pocket monies, clear individual accounts and records are maintained. Comments received from staff and management confirmed that there are good health and safety policies and practices that promote the health, safety and welfare of residents and staff. All staff members do refresher training in Health and Safety, such as moving and handling, fire safety and food hygiene. This helps reinforce the registered provider’s written policies on Health and Safety. Health and Safety issues are also discussed at staff meetings. Residents and staff expressed satisfaction with the way the home was run and the good standards that were evident in many instances. They said they believed the home was safe and run in the best interests of residents. However, formal consultation with service users and their representatives should be implemented, via meetings and surveys, to ensure that management invite feedback on the home’s performance and suggestions for improvement. The findings of such consultations should be shared with service users and others within the home (for example, by way of a newsletter). Four Winds Residential Home DS0000045233.V317988.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 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 3 x x x x 2 x 3 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 2 x 3 3 x 3 Four Winds Residential Home DS0000045233.V317988.R01.S.doc Version 5.2 Page 22 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 OP1 Regulation 5, 6 Requirement The home’s service user’s guide needs to be a separate document to the statement of purpose. It must include all of the items specified in regulation 5 and be made available to all service users and prospective service users. In the home’s terms and conditions of residence/contract, the information about fees and complaints needs to be elaborated further, giving timescales for complaint investigation and conditions under which fees may be refunded, in line with regulations. The legislation quoted needs to be checked and amended where necessary. Suitable locks are required to be fitted to bedroom doors. The previous timescales of 01/12/05 and 30/04/06 were not met. Formal consultation with service users and their representatives
DS0000045233.V317988.R01.S.doc Timescale for action 28/02/07 2. OP1 5, 6 28/02/07 3. OP24 23, 12 31/03/07 4. OP33 24 31/03/07 Four Winds Residential Home Version 5.2 Page 23 should be implemented, via meetings and surveys, to ensure that management invite feedback on the home’s performance and suggestions for improvement. The findings of such consultations should be shared with service users and others within the home (for example, by way of a newsletter). 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 OP21 Good Practice Recommendations The first floor bathroom would benefit from being upgraded to permit assisted bathing. Provision of a level entry shower should be considered to provide service users choice and convenience. One en suite toilet requires a call point to be fitted. The Registered Manager is expected to achieve National Vocational Qualifications (NVQ) at level 4 in management and care within a reasonable time (for example, 12 to 18 months). 2. 3. OP21 OP31 Four Winds Residential Home DS0000045233.V317988.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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