CARE HOMES FOR OLDER PEOPLE
George Hythe House 1 Croft Road Bennion Road Leicester LE4 1HA
Lead Inspector Ruth Wood Announced 19 April 2005 09:30 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. George Hythe House Version 1.10 Page 3 SERVICE INFORMATION
Name of service George Hythe House Address 1 Croft Road Bennion Road Leicester LE4 1HA 0116 2350944 0116 2366560 LQHALTD@TALK21.com Leicester Quaker Housing Association 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) Under application Care Home 41 Category(ies) of DE(E) Dementia - over 65 (31) registration, with number MD(E) Mental Disorder - over 65 (31) of places OP Old age (41) PD(E) Physical disability - over 65 (41) George Hythe House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 06/10/04 Brief Description of the Service: George Hythe House provides a service for 41 older people, some of whom have mental health needs and/or physical disabilities. The home was purpose built in 1993 and is owned and managed by the Quaker Housing Association. The home has 41 single rooms, all of which have en-suite facilities. The accommodation is on two floors, serviced by a shaft lift. There is a large communal lounge on the ground floor and a smaller lounge with attached dining and kitchen facilities on the first floor. The latter is used primarily as the focus for activity sessions. The Home is divided into four wings, each having its own dining room and kitchen. Outside there is a garden with seating areas. George Hythe House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This Announced Inspection took place between 9.30am and 5.30pm with an additional visit of one hour being made the following day to view staff records. Planning for the inspection took approximately 2.5 hours and included reading the Pre-Inspection Questionnaire together with the 20 Comment Cards from residents and the 26 from their relatives. The notifications of significant events sent to the Commission for Social Care Inspection by the home were also reviewed, as were the findings from a Complaints Investigation held in October last year. The Commission is currently processing a manager registration application. As part of the Inspection, discussion was held with the Acting Manager, five staff members, eight residents and two relatives. Care practice was directly and indirectly observed and records were examined. What the service does well: What has improved since the last inspection?
Daily records are now more detailed and factual rather than expressing the opinion of the person writing them. Staffing in the home is more flexible with some domestic staff being trained to do certain aspects of care work. A
George Hythe House Version 1.10 Page 6 greater level of interaction between residents and staff was observed than at previous inspections. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. George Hythe House Version 1.10 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 George Hythe House Version 1.10 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) 2,3,4,5 Residents’ needs are generally well assessed before they move into the home and their needs are well met although improvement is needed in the assessment and documentation of pressure area care. Arrangements for trial visits are flexible and allow residents and their families to get to know the home. Each resident has a clearly written statement of terms and conditions with the home. EVIDENCE: Copies of Terms and Conditions and Individual Placement Agreements were contained in residents’ files. Residents’ files contained a record of the home’s assessment together with comprehensive assessments from placing social workers. The home does not formally assess and document residents’ risk of developing pressure sores. Residents said they had visited the home before moving in and some residents’ files documented the extension of trial periods. George Hythe House Version 1.10 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) 7,8,9,10 Improvement is needed in the monitoring and review of care plans and the clarity of risk assessments. Residents’ health needs are generally well met but improvement is needed in the interventions taken for residents identified as being at risk of falls and in the administration of medication. Service users are generally treated with dignity and respect and their privacy is upheld. EVIDENCE: All residents’ files examined (six) contained a care plan. Care plan reviews tended to duplicate the original plan rather than concentrate on changes. It was not always clear from documentation of the exact date of reviews or if residents were actively involved. One resident’s care plan did not accurately reflect their recently re-assessed needs. Risk assessments were not always clearly dated. Assessments for residents at risk of falls frequently placed unrealistic emphasis on residents with dementia ringing for help before moving. Daily records were sufficiently detailed and factual as required following a Complaints Investigation in October. Residents have regular access to their GP, chiropody, dental and optical services.
George Hythe House Version 1.10 Page 10 The staff member administering medication placed tablets directly into a resident’s mouth and also handled medication before placing it in galley pots. They did not wash their hands during the medication round. The medication administration record was signed before some residents were given their medication. Residents were asked if they required pain relief medication before this was administered and were also asked which kind of drink they wanted to take their medication with. Staff were observed to knock on doors and wait for a reply before entering. One hard of hearing resident’s room has been fitted with a loud bell so that they knew when someone was at the door. Seventeen of the eighteen residents who responded to this question on their Comment Card said that staff respected their privacy with one resident saying they sometimes did. Staff were observed to speak to residents in a respectful way however one staff member was observed to place a lifting belt around a resident without asking permission, explaining what was to happen or engaging in any communication with that resident. George Hythe House Version 1.10 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) 12,13 The home provides a diverse range of activities that meet the social, cultural, religious and recreational needs of the vast majority of its residents. Continued contact with relatives and friends is facilitated and encouraged by the home if this is the resident’s wish. EVIDENCE: The home has a dedicated activities organiser who plans a programme of activities on a monthly basis. A copy of this plan is circulated to all residents and additional copies are placed on the Wing notice boards. A special activities programme is offered for residents with dementia. The home has a dedicated area for activities which includes kitchen facilities that residents can use. Activities include musical evenings, scrabble, craft and a Bird and Poetry Group which is organised by one of the home’s residents. A Church of England Holy Communion Service is held once a month. There are currently no residents of other faiths living in the home. Planned outings to local beauty spots such as Ulverscroft Grange are arranged together with more spontaneous outings to local shops. Residents and their relatives were very positive about the activities provided by the home. Of the 17 residents who responded to this question 16 said that the home provides suitable activities with 1 stating that they sometimes do. One relative said, “The activities in the home are a big bonus for residents.”
George Hythe House Version 1.10 Page 12 One resident said that they did not feel any of the activities on offer were culturally appropriate for them. All 26 respondents to the relatives survey said that they were welcomed in the home at any time and could visit their relative/friend in private. One visiting relative commented “I’m always made welcome when I come here”. Staff were observed to greet visitors warmly, offer them a drink and ask if they wanted a more private space to meet. George Hythe House Version 1.10 Page 13 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 actively promotes its Complaints Procedure and acts promptly upon issues raised. Policies and procedures in place to protect residents from abuse are generally good although the home could do more to promote its whistle blowing policy. EVIDENCE: The Complaints Procedure is clearly written and prominently displayed on notice boards throughout the home. Residents, their relatives and friends are regularly reminded of the policy at home meetings. The home has met the majority of Requirements and Recommendations made following a Complaints Investigation conducted by the Commission in October 2004. A summary of this Investigation is attached to this Report. A relative commented on problems they had raised with the home, “Most problems have been listened to and have been or are being dealt with.” Another relative commented, “The one time I needed to make a complaint the manager rang me at home more than once. The issue was resolved quickly and to my satisfaction.” Staff have received training in the recognition and prevention of abuse and those interviewed were able to identify the different types of abuse that they could encounter. Some staff spoken with were unclear as to their responsibilities under the home’s whistle policy. George Hythe House Version 1.10 Page 14 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) These Standards will be assessed at the home’s next inspection later in the year. EVIDENCE: George Hythe House Version 1.10 Page 15 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 There are usually sufficient, competently trained staff on duty to meet residents’ needs and there is a positive relationship between residents and staff. Recruitment practices are robust but copies of staff records need to be available for inspection at the home. EVIDENCE: Rotas showed that there are at least five care staff on duty plus at least one senior carer at any one time during the day and two waking staff at night. In addition the home employs catering, laundry and domestic assistants. The latter have received training in moving and handling and dementia care and assist with caring activities if required. The home appeared well staffed on the day of the inspection and 23 of the 26 relatives who responded to the Commission’s survey felt that there were always sufficient numbers of staff on duty. Both residents and their relatives expressed a high level of satisfaction with the staff team. Typical comments made included, “Staff seem helpful conscientious and cheerful.” “The staff should be commended for their commitment.” “The staff at the home have given my mother first class attention.” A record is kept of all staff members’ training; training appears appropriate to the identified needs of residents. The Acting Manager currently has no direct control over the home’s training budget and has little input into the selection of appropriate courses for staff.
George Hythe House Version 1.10 Page 16 Evidence of staff references and Criminal Records Bureau checks were not immediately available, being kept at the Quaker Housing Association’s head office. Copies of these should be kept at the home. George Hythe House Version 1.10 Page 17 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) 33,36,38 The home consults regularly with its residents and their families and tries to operate in the residents’ best interests. Staff members are appropriately supervised. Some improvements are needed in the area of resident health and safety. EVIDENCE: Regular meetings are held for staff, residents and relatives and residents are consulted about issues such as menus and activities. Relatives and residents are informed of forthcoming inspections by individual correspondence and encouraged to complete the Commission’s Comment Cards. The home’s policies and procedures are reviewed on an annual basis. Staff receive regular one to one supervision the details of which are recorded. A resident was observed being transferred in a wheelchair without their feet being placed on the footplates. A call bell was placed out of reach of a resident
George Hythe House Version 1.10 Page 18 with limited mobility. The water temperature in two wings of the building ranged from 56 to 57 degrees centigrade. George Hythe House Version 1.10 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 15 x
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 3 x x 3 x 1 George Hythe House Version 1.10 Page 20 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 3 Regulation 14 Requirement An formal assessment must be undertaken for each resident focussing on the risk of their developing presssure sores. This, together with the preventative measures to be taken, must be clearly documented. The care plan of the identified resident must be updated to reflect their current needs. Care plan reviews should focus on areas of changing need rather than duplicating the original plan. They must show evidence of residents involvment where possible. Following a change in a residents needs, risk assessments must be fully updated rather than ammended. All risk assessments must be dated and signed. A risk assessment for the identified resident in relation to sitting in their wheelchair must be completed and a copy sent to the Commission. The Acting Manager must formulate a stategy to improve practice in relation to the
Version 1.10 Timescale for action By 31 May 2005 2. 3. 7 7 15 15 By 15 May 2005 With immediate effect 4. 7 15 With immediate effect 5. 7 15 By 15 May 2005 6. 8 13 By 31 May 2005 George Hythe House Page 21 7. 9 13 8. 9 13 9. 10 12 10. 18 13 11. 29 17 12. 38 13 13. 14. 38 38 13 13 prevention of falls for residents, identified as being at risk in this area. Risk assessments must not continue to place an unrealistic responsibility on residents with dementia to ring for staff to lessen their risk of falling when moving. Staff who administer medication must avoid handling medication or placing it directly in residents mouths. Staff who administer medication must sign the medication record after medication has been administered and not before. The Acting Manager must ensure that all staff at all times communicate their intended actions to residents and where appropriate gain permission from the resident before they proceed. The Acting Manager must ensure that all staff are aware of their responsiblities under the homes whistle blowing policy. Copies of Staff records, including evidence of Criminal Records Bureau Clearance must be kept at the home. All staff must ensure that footplates are correctly used when transferring residents in wheelchairs. Call bells must be placed within easy access of residents with limited mobility. The valves that regulate water temperature must be serviced to ensure that the temperature does not exceed 43 degrees centigrade. Staff must be made aware of the potential danger from hot water and report any increase in water With immediate effect With immediate effect With immediate effect By 31 May 2005 By 31 May 2005 With immediate effect With immediate effect With immediate effect George Hythe House Version 1.10 Page 22 temperatures to the senior staff member on duty. 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 7 8 Good Practice Recommendations Significant incidents in the daily record should be marked with a highlighter pen to assist the ongoing review of residents needs A separate list of health care appointments should be kept on residents files together with details of any action required by care staff. Such action should also be included on the residents care plans. The Acting manager should have more input into the selection of appropriate training courses and the management of the homes training budget. Records of Supervision meetings should be signed and dated by both parties. 3. 4. 30 36 George Hythe House Version 1.10 Page 23 Commission for Social Care Inspection The Pavilions, 5 Smith Way Grove Park, Enderby Leicester LE19 1SX 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 George Hythe House Version 1.10 Page 24 - 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!
