CARE HOMES FOR OLDER PEOPLE
Glen, The 57 Part Street Southport Merseyside PR8 1JB Lead Inspector
Mrs Elaine White Unannounced Inspection 22nd and 30th November 2005 09:30 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, The DS0000005323.V266444.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Glen, The DS0000005323.V266444.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Glen, The Address 57 Part Street Southport Merseyside PR8 1JB 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) 01704 544332 01704 544332 Miss Carol Lynn Marshall Miss Carol Lynn Marshall Care Home 10 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (10) of places Glen, The DS0000005323.V266444.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Service users to include up to 10 OP The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The service is registered to provide personal care to one named service user in the category of DE(E). This variation will cease when the service user is no longer resident 20th July 2005 Date of last inspection Brief Description of the Service: The Glen is a private family run residential care home, which provides personal care and support for up to 10 elderly residents. The home is owned and managed by Ms. Carol Marshall who provides hands on care and support to the residents and staff. Nursing care is provided by the nursing services when required. The home is located close to the town centre of Southport. Amenities provided within the town include cinema, shops, restaurants, pubs and parks. These can be accessed by local transport or within walking distance of the home. The Glen is a large detached property, within its own grounds. The owner purchased the property as an existing care home. The accommodation is located on two floors. There is no lift access provided. The home provides a dining room, which caters for all residents. A large comfortable lounge is located on the ground floor. Parking is available at the front entrance. Disabled access is provided via a portable ramp to the front garden. A call system is available throughout and assisted bathing facilities. All residents are registered with a GP. Positive comments were received from the residents on the service provided. Glen, The DS0000005323.V266444.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was an unannounced visit, which took part over two days and was conducted as part of the regulatory requirement for care homes to be inspected at least twice a year. A tour of the building was conducted. The home provides a warm, friendly, clean and comfortable environment for the residents to live. Case tracking was conducted on three residents to assess the care and support provided. A selection of care, staff and home records was also viewed. The manager, staff and three of the nine residents were spoken with and their views obtained of the home. The home had a vacancy at the time of the inspection. Comments received have been favourable regarding the home and the very caring nature of the staff and the standard of the environment and atmosphere in the home. What the service does well:
The home provides a very clean, pleasant, homely, relaxed and comfortable atmosphere. Rooms viewed were found to be ‘spotless’, with clean fresh bedding, pleasant smells and no offensive odours. On the second visit the home had been decorated for Christmas and the residents commented on how attractive it looked. The home is resident focused and relatives and friends are encouraged to call in as often as they wish. Visitors are made welcome and invited to stay for lunch with their relatives. One resident said, “My family are always made welcome and will be calling on Christmas day”. Since the last inspection the manager has been on maternity leave and has only recently returned. The residents commented that they have been satisfied with the care and support provided during her absence. “We have wanted for nothing”. “It’s lovely when Carol (manager) calls in with her baby”. An ongoing training programme is in place, which provides the staff employed with the necessary skills to enable them to deliver care and support to the residents. The home is committed to providing NVQ (National Vocational Qualifications) for their employees. The manager has a qualification in NVQ Level 4 and the deputy has NVQ Level 2 and 3. Staff provide a personal approach to the care and support of the residents. One resident said, “A Glen, The DS0000005323.V266444.R01.S.doc Version 5.0 Page 6 member of staff is taking me to the hospital as my daughter can’t make it and I can’t go by myself”. “I need help with everything and they are lovely”. There is a low turnover of staff, which ensures continuity of care to the residents. No agency staff are employed. Residents commented, “I am very happy here and everyone is very nice”. “They are a good crowd”. “It’s a lovely family atmosphere”. Discussion with staff and viewing of records confirmed that supervision is in place. The recording systems are well organised and kept up to date. A varied menu is available and alternatives are offered. Meals are flexible to suit the needs of the residents. Residents commented, “The food is excellent”. “I have trouble swallowing but they always find me something I like”. “They always make me sandwiches at 11.00pm and a night flask. I am spoiled”. “They will do my breakfast when I feel like it”. What has improved since the last inspection? What they could do better:
A number of requirements from the last inspection have yet to be met. This is due to the maternity leave of the manager and will be addressed in the near future. Radiator covers are not in place, however the manager conducts risk assessments to assess this risk. The home is yet to be assessed by a qualified occupational therapist who has specialist knowledge of the needs of the client group.
Glen, The DS0000005323.V266444.R01.S.doc Version 5.0 Page 7 The activity programme is to be surveyed with the residents to ensure that it meets their needs and choice. The manager is to provide a ‘chair exercise’ activity in the near future. The laundry room in the basement requires repainting. 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, The DS0000005323.V266444.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Glen, The DS0000005323.V266444.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Prospective residents are encouraged to visit the home and assessments are completed prior to admission to ensure their needs can be met. EVIDENCE: Three care plans were viewed and were found to contain up to date information on the assessed needs of the residents. Records showed that care plans are reviewed monthly and changing needs are addressed. The home provides access to health care services, were required and records of all visits are made. Two service users receive a diabetic nurse visit twice daily to monitor their progress. Staff training programmes in place ensure that they are able to meet the needs of the residents. Glen, The DS0000005323.V266444.R01.S.doc Version 5.0 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): 7,8,9,10. Care plans record the health care needs of the residents. Access is available to health care services. Medication policies and procedures are in place. Residents are treated with dignity and respect and are assured at their time of death their wishes will be addressed. EVIDENCE: Three care plans were viewed and were found to contain up to date information on the assessed needs of the residents. All care plans are reviewed monthly with the residents to monitor changing needs. Daily records are maintained of all care needs, visits to and by health care services, relatives and visitors. Changes in need, action taken and outcomes are recorded. Discussion took place with the residents to confirm that the care provided reflected their care plans and that access is available to health care services. Residents interviewed commented,” I like to go out often and they organise the district nurse around me so I don’t miss my injections”. “Betty (carer) is coming to the hospital with me as my daughter can’t make it”.
Glen, The DS0000005323.V266444.R01.S.doc Version 5.0 Page 11 Residents spoken to provided positive comments on the care and support provided and the pleasant, caring attitude of the staff. “I need help all the time and all the carers are lovely”. “Carol looks after me. She is very nice”. Medication policies and procedures are in place and all administrations are recorded. Medication is securely stored and a separate fridge is provided for insulin. Glen, The DS0000005323.V266444.R01.S.doc Version 5.0 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. The home provides a pleasant, homely and comfortable environment for the residents. The residents have choice and control over their lives. EVIDENCE: Observation and discussion with residents, staff and viewing of records confirmed that the residents have choice and control in the way they conduct their lives. A number of residents are able to go out independently to access the community. One resident said that the home organises his health care and meals around him to enable him to do this. “I am going on a trip and they have organised my district nurse around me”. Families and friends are made welcome and residents are able to stay with their relatives for short breaks or go for weekly visits. One resident goes to her daughters every week for lunch and said she had recently been to a party at the church “I had a lovely time”. Families and visitors are encouraged to call, maintain contact with their relatives and stay for lunch if they wish. One resident said, “My daughters visit me everyday and phone me every night”. The home is to conduct a resident’s survey on the activities in place to ensure they are providing what they want. The manager is looking to providing ‘chair exercises’ in the near future. Glen, The DS0000005323.V266444.R01.S.doc Version 5.0 Page 13 Meals are served in a pleasant dining room and residents have the choice of eating in their own rooms if they wish. Menus are in place and alternatives are available. Residents spoken to provided positive comments on the food provided. “The food is excellent”. “If I fancy anything I just have to ask”. Residents and their families are encouraged to look after their finances. A number of residents have their own bank accounts and the manager is not appointee for any resident. Glen, The DS0000005323.V266444.R01.S.doc Version 5.0 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): 16,17,18. Policies and procedures are in place to protect residents form abuse. Residents are aware of how to make a complaint. A robust recruitment and selection procedure is in place. EVIDENCE: No complaints have been recorded since the last inspection. Residents spoken to expressed that they are aware of how to make a complaint should they have one. This information is contained in the service user guide. Policies and procedures are in place on abuse. All staff are provided with this information on induction and this regularly updated within the home’s training plan. All staff are recruited and selection through the correct procedure, which involves POVA checks (protection of vulnerable adults) and 2 written references are obtained. Glen, The DS0000005323.V266444.R01.S.doc Version 5.0 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): 19. The home provides a homely, comfortable and clean environment for the residents to live. EVIDENCE: A number of private rooms were viewed and all the communal areas. These were found to be comfortably furnished, spotlessly clean and homely. A programme of planned maintenance is in place. Repairs, decoration and improvements are undertaken when needed to maintain the standard. The grounds are attractive, kept tidy and safe and provide a pleasant outlook from the accommodation. Residents commented on their satisfaction with the homely, comfortable environment. Individual rooms are personalised with their own possessions and residents said they are very satisfied with their accommodation. A number of requirements are yet to be addressed from the last inspection. These have been delayed due to the managers’ absence on maternity leave.
Glen, The DS0000005323.V266444.R01.S.doc Version 5.0 Page 16 These are contained in the requirements of this report. A risk assessment is now in place for the use of the portable ramp at the front entrance. Glen, The DS0000005323.V266444.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30. Sufficient staff are on duty to meet the needs of the residents. Training is in place to ensure competency of their role. The procedures for the recruitment of staff are robust and include necessary Protection of Vulnerable Adult (POVA) checks prior to employment on all staff. EVIDENCE: Records viewed, observation during the inspection and discussion with staff and residents demonstrated that sufficient staff are on duty to meet the needs of the residents. The home has a low staff turnover, which ensures continuity of care. Residents commented positively on the staff employed. “The carers are all lovely”. “Carol looks after me she is very nice”. Staff spoken to and records viewed confirmed that a training plan is in place and they are encouraged to take qualifications in NVQ. Staff meetings take place every 6 – 8 weeks. A robust recruitment and selection process is in place and records showed that all staff are employed following a satisfactory CRB (criminal record bureau check) and 2 written references. An induction process is in place to ensure staff are aware of their roles and responsibilities.
Glen, The DS0000005323.V266444.R01.S.doc Version 5.0 Page 18 Glen, The DS0000005323.V266444.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35,37. Residents and their families are encouraged to manage finances. Policies and procedures are in place to safeguard the residents. EVIDENCE: The registered manager is experienced in the care of older people and has a qualification in NVQ Level 4, Registered Managers Award. Residents spoken to gave positive comments regarding the care, support and direction the manager provides. “Carol is very approachable ”.“Carol is very nice”. A positive, open atmosphere was witnessed during the inspection. . The manager is in day-today control of the home and has developed well-organised systems, procedures and records. Glen, The DS0000005323.V266444.R01.S.doc Version 5.0 Page 20 Records are up to date on all certificates required for services in place i.e. Gas, electricity and bath lift. Fire safety and water temperatures are recorded. Polices and procedures are reviewed annually. The manager encourages residents and relatives to deal with finances and is not appointee for any resident. Four of the nine residents maintain their own bank accounts. All financial transactions made for ‘personal allowances’ are accounted for and receipts obtained. Glen, The DS0000005323.V266444.R01.S.doc Version 5.0 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 X X 3 X X X 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 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 X X X X X X X 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 X X X X 3 X 3 X Glen, The DS0000005323.V266444.R01.S.doc Version 5.0 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 OP19 Regulation 23 Requirement The registered person shall obtain an assessment of the building by a qualified occupational therapist to ensure the home is suitable for the client group. (Time scale at last inspection not met). The registered person shall redecorate the laundry walls. (Time scale at last inspection not met). Timescale for action 31/03/06 2. OP26 23 31/03/06 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. 2. Refer to Standard OP15 OP38 Good Practice Recommendations Regular surveys of the activity programme should take place to demonstrate residents’ needs and interests are being met. The manager should continue to provide risk assessments for all residents in the absence of radiator covers. Glen, The DS0000005323.V266444.R01.S.doc Version 5.0 Page 23 Glen, The DS0000005323.V266444.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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