CARE HOMES FOR OLDER PEOPLE
Glen Rosa & Kitwood House 24 Grove Road Ilkley West Yorkshire LS29 9PH Lead Inspector
Barbara Grell Unannounced Inspection 8th February 2006 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 Glen Rosa & Kitwood House DS0000001243.V280402.R02.S.doc Version 5.1 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. Glen Rosa & Kitwood House DS0000001243.V280402.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Glen Rosa & Kitwood House Address 24 Grove Road Ilkley West Yorkshire LS29 9PH 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) 01943 609604 01943 817363 llk@mha.org.uk home.fxg@mha.org.uk Methodist Homes for the Aged Mrs Susan Sullivan Care Home 47 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (33), of places Physical disability over 65 years of age (3) Glen Rosa & Kitwood House DS0000001243.V280402.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th July 2005 Brief Description of the Service: The home is owned and run by Methodist Homes for the Aged a national voluntary organisation. Glen Rosa and Kitwood House are situated on Grove Road in Ilkley, close to the town centre and public transport. The house is situated in large, well-maintained grounds and gardens that provide for ample car parking. The main building is a period property that has been converted and extended and now provides accommodation for thirty-three older people. The extension, Kitwood House has been built for the purpose of providing care to 14 older people with dementia. There is ramped access to the side of the building to provide access for those using mobility aids. Glen Rosa & Kitwood House DS0000001243.V280402.R02.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced on 08 February 2006 commencing at 9:30 and the site visit finished at 15:00. In line with CSCI policy a number of core standards were assessed including any outstanding items. Reports and information on this and other social care services can be accessed on the Internet on www.csci.org.uk. The following methods were used in judging the quality achieved. Two service users files were inspected to assess the quality of assessment, care planning, general recording and review. The level of service user choice and involvement in decision making was in particular looked at. A further five records were looked at to assess the level of assessment and planning in respect of illness, dying and death (Standard 11). Policy and practices that protect the health and safety of service users were assessed. This included risk management, hygiene practices and infection control. The numbers and skill mix of staffing at the home was looked at using the duty rota and discussion how this area is reviewed. The quality assurance and management system was discussed and records looked at. Seven members of staff including the manager were involved and had discussion with the inspector commenting on policy and practices in the home. The inspector had lunch with the service users in Kitwood House and was able to observed practices. Four service users resident in Glen Rosa were also able to make comment and activities observed during the morning and after lunch. What the service does well:
The building provides very good environments both for the older service users in Glen Rosa and those having a diagnosis of dementia within Kitwood House. The special facilities in Kitwood House ensure the safety of individuals whilst ensuring that all have free movement within the communal areas and the secure gardens. The resident’s benefit from a building that provides appropriate facilities is well maintained and pleasant. Residents appreciate that their privacy is maintained. The record keeping showed that there is a good level of assessment, care planning and review in meeting the changing needs of service users. There is good evidence that service users are involved in all aspects of this process and in line with their skill level. Individual’s expectations are ascertained and
Glen Rosa & Kitwood House DS0000001243.V280402.R02.S.doc Version 5.1 Page 6 clearly inform the way that care is provided to each individual. Resident’s have good confidence in the manager and individuals are able to have conversation and discuss any areas of concern with her promptly and in private. The skill mix and numbers of staff are appropriate in meeting the needs of the service users. The staff team feel that they benefit form ‘regular’ and ‘ongoing’ training. Individuals were able to discuss a variety of good practices. Resident’s benefit from a staff team that understands their needs and takes account of individual expectations. Good risk management ensures that the home is well maintained. Quality assurance undertaken ensures that service users have ‘their say’ and improvements and developments can be ensured in line with current good practices. The manager is competent and aims at achieving high standards in all areas of practice at the home. She is able to identify areas for improvement and development and follows a system of review and development. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Glen Rosa & Kitwood House DS0000001243.V280402.R02.S.doc Version 5.1 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 Glen Rosa & Kitwood House DS0000001243.V280402.R02.S.doc Version 5.1 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 the following standard(s): 1&5 Good information is provided about the home, it’s services and facilities. Prospective service users and their representatives have an opportunity to ‘test the home’, are invited to visit and meet a member of the staff prior to admission. EVIDENCE: The statement of purpose has been reviewed and now includes all the details as required. This document is available alongside other information to service users and visitors in the entrance. Individuals are well informed. There is a good amount of information provided to service users including service user guide/brochure, complaints procedure and feedback from surveys of visitors and residents. Prospective service users and their representatives including their family are invited to visit the home prior to admission. The manager said that some take advantage others do not. Staff from the home visit individuals in their current situation prior to admission to undertake an assessment of needs. When a service user is supported under care management arrangements an
Glen Rosa & Kitwood House DS0000001243.V280402.R02.S.doc Version 5.1 Page 9 assessment is obtained additional to the homes staff undertaking their own assessment. Glen Rosa & Kitwood House DS0000001243.V280402.R02.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 11 EVIDENCE: Appropriate assessment tools are used to record the needs assessment. Documents showed that staff undertake regular review and take account of the individuals changing needs. The care plans are personalised and give clear details of individual’s wishes and expectations in respect of their care needs. This is good practice. Reasons for admission and personal histories are well recorded in ensuring that the expectations of individuals are known and acted upon. Personal, social, emotional and religious needs are well documented giving good details about the input needed from staff and outcomes aimed for. The care plans take account of any medical needs an individual may have. NHS staff provides any medical and nursing treatments required by service users. Care plans take account of the service users needs in respect of nutrition, skin viability and falls. Pressure relieving equipment is provided when needed. The menu plans ensure that individual dietary needs are met and choices offered to all.
Glen Rosa & Kitwood House DS0000001243.V280402.R02.S.doc Version 5.1 Page 11 A recorded schedule of the individuals preferred daily routine ensures that individuals are able to continue their previous lifestyle and routine as much as possible. Individuals felt well cared for and remained in control of their routines. Observational techniques enable staff to make judgements about the well being of service users who are not able to communicate their needs verbally. Staffs working in Kitwood House were highly skilled in supporting the service users with dementia. The outcome is a calm atmosphere that benefited this group. Individuals were encouraged to maintain their skill level and staff clearly knew each individual’s limitations and ability and when help is needed. Five files were inspected to judge the standards of records kept in documenting the service user final wishes and wishes should they become ill. One file seen included no details. Three gave details about nominated members of the family that would be involved in any final arrangements. One stated that an individual did not wish to be resuscitate, however, the service user did not sign this entry. Hence it can be said that the quality of entries is patchy and recording does not meet the standard expected. The inspector advised the manager of the ‘Liverpool Pathway’ and other good practice tools that would be beneficial in developing this area. Glen Rosa & Kitwood House DS0000001243.V280402.R02.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 & 15 The residents enjoy a choice of activities that meet their expectations and wishes. Individuals felt in control of their lives and routine in the home. Resident’s benefit from a choice of wholesome meals. EVIDENCE: There are regular activities at the home and individuals can choose to join in or not. Activities include light exercise, movement to music, arts, crafts, reminiscence and a variety of religious services and bible groups. Those spoken to say that there was enough provision in addition to their own interests. Many enjoyed the outdoors during the fine day of the inspection. Many go for walks and seating is provided. Individuals spoken to were clear that their individual wishes and opinion are sought and acted upon. The routines matched individual’s expectations. All were clear that there are few restrictions and ample choices. The mealtime within Kitwood House was very well managed. Residents could eat at their own pace. Choices were offered to all and individual’s needs and wishes were reflected within potion size and choice of meal. Visual prompts were provided when needed. Staff assisted a number of individuals to take their meal. This was done discreetly and appropriately. A calm atmosphere
Glen Rosa & Kitwood House DS0000001243.V280402.R02.S.doc Version 5.1 Page 13 was achieved that enabled individuals to take their meal peacefully. sensitive and appropriate input from staff was well done. The Glen Rosa & Kitwood House DS0000001243.V280402.R02.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Staffs are provided with training, policies and procedures to enable them to detect and take appropriate action to protect service users from abuse. EVIDENCE: The staff spoken to say that they had received training in this area. There are procedures in place including the local social services department adult protection policy. There have been no concerns affecting service users in the home. Further training is planned in this area over the next few months in order to ensure that there is regular update amongst the team. Additionally some staff have undertaken a course named ‘challenging behaviour in the workplace’. Glen Rosa & Kitwood House DS0000001243.V280402.R02.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 The home is clean and hygiene schedules ensure practices that prevent the spread of infection. EVIDENCE: Policies and practices have come under scrutiny during a recent outbreak of diarrhoea and vomiting. Practices were changed and improved after recommendations made by the environmental health officer. Equipment was changed in line with the recommendations made including the use of the already available steam cleaner in sanitising areas regularly and effectively. Staffs were provided with additional training and supervision to improve practice. The manager undertakes ongoing quality assurance checks to ensure that all new practices are consistently achieved. Many environmental standards have been exceeded (see previous report). Glen Rosa & Kitwood House DS0000001243.V280402.R02.S.doc Version 5.1 Page 16 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): 27 There is a good skill mix and appropriate numbers of staff are on duty to meet the needs of the service users. EVIDENCE: A staff rota was provided during the inspection. This showed that there are sufficient numbers of staff on duty to meet the needs of the service users. Staff spoken to felt that there is good team working. Staff felt well supported to undertake training and all felt that the training provision was high. Staff stated that they were regularly supervised and that their duties and responsibilities are made clear. Service users felt that staff are well trained and skilful. staff are attentive, respectful and friendly. Residents said that Glen Rosa & Kitwood House DS0000001243.V280402.R02.S.doc Version 5.1 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 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): 31, 32, 33 & 38 The home is well-managed and regular review of policy and practice ensures that a good quality of service is achieved and maintained. EVIDENCE: Susan Sullivan, the manager is in the process of completing her NVQ level 4. It is anticipated that she completes this training by September 2006. Staff and service users felt involved in the decision-making processes at the home. There are regular staff and service user meetings. Two service users came to speak in private with the manager during the inspection. Both had good confidence in the manager to deal with their issues. An open door policy and management style that put service users first was highly apparent. The manager and other designated staff are involved in monitoring the standards achieved. Susan Sullivan regularly undertakes tours of the building,
Glen Rosa & Kitwood House DS0000001243.V280402.R02.S.doc Version 5.1 Page 18 spot checks entries in the recording systems for accuracy and quality. This is good practice and shows good quality management being achieved. There is much feedback available from service users and their representatives that show a high level of satisfaction with the care and services at the home. The manager undertook a self-assessment against the applicable minimum standards. This was found to accurately reflect the standards achieved in the home. Equipment in use is regularly maintained, serviced and checked by persons qualified to do so. This includes small electrical appliances, lifting equipment and gas appliances. Contracts are in place to ensure the appropriate removal of clinical waste from the home. Glen Rosa & Kitwood House DS0000001243.V280402.R02.S.doc Version 5.1 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. 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 3 X X X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 4 3 X X X X 3 Glen Rosa & Kitwood House DS0000001243.V280402.R02.S.doc Version 5.1 Page 20 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. 2. Standard OP31 Regulation 8 Requirement The registered manager must hold an NVQ level 4 in care and management. Timescale for action 01/01/06 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 OP11 Good Practice Recommendations The service users wishes concerning terminal care and arrangements after their death are discussed and recorded. It is recommended that good practice guidance such as the Liverpool Pathway be used. Glen Rosa & Kitwood House DS0000001243.V280402.R02.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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