CARE HOMES FOR OLDER PEOPLE
Glencoe 10-11 Chubb Hill Whitby North Yorkshire YO21 1JU Lead Inspector
Mary Slattery Unannounced 10 August 2005 at 11:00am
th 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. Glencoe J53_J04_S44875_Glencoe_V226988_250505_stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Glencoe Address 10-11 Chubb Hill Whitby North Yorkshire YO21 1JU 01947 602944 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) Endeavour Care Ltd Mrs Linda Magill Care Home 19 Category(ies) of Dementia (19), Old age, not falling within any registration, with number other category (19) of places Glencoe J53_J04_S44875_Glencoe_V226988_250505_stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 19th October 2004. Brief Description of the Service: Glencoe is a care home providing personal care and accommodation for up to 19 older people with dementia. The home is located close to the town centre of Whitby and it leisure facilities and amenities. Glenco is a large detached house with a small garden to the front and a patio area at the back of the house with a a range of seating availble to the service users. Access to the front of the house is via a flight of staps and via a path at side of the house. Parking is limited on the road at the front. The home is owned by Endeavour Care Limited and was registered in 2003. Glencoe J53_J04_S44875_Glencoe_V226988_250505_stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report relates to an unannounced inspection of the home carried out on the 10th August 2005. The inspection took 3 hours plus 2 hours preparation time. A tour of the premises was carried out which included the service users private accommodation. A selection of records were looked at and time was spent observing the activity in the home and how staff interacted with the service users. The focus of the inspection was on a number of key standards and case tracking service users to see if their needs and expectations were met. The registered manager was available throughout the inspection and the findings were discussed with her at the close of the inspection. What the service does well:
Provides people with information about the services and facilities and invites people to visit the home to look around, meet the staff before they decide to move in. The staff encourage and support service users relatives and friends to visit to maintain their relationships and be involved in their care as far as possible. The staff spend time with the service users, engaging in individual activities, keeping up with the local news, helping them with shopping and trips out in the community. The staff were sensitive towards service users at lunch time, they made sure they had the help they needed and were both encouraged to eat lunch and offered a choice from the varied menu. The home employs dedicated domestic staff as the whole house was clean and free from offensive odours and there was a good provision of protective clothing for the staff. All of the service users were smartly dressed and well groomed. Where service users needed assistance with their personal care this was carried out in private. The staff were observed to interact with the service users well, treating them with respect and addressing them in a polite manner. The medication records were in good order and staff kept detailed daily records in the service users care plan about the care that had been delivered and any changes in their conditions. Glencoe J53_J04_S44875_Glencoe_V226988_250505_stage4.doc Version 1.30 Page 6 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. Glencoe J53_J04_S44875_Glencoe_V226988_250505_stage4.doc Version 1.30 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 Glencoe J53_J04_S44875_Glencoe_V226988_250505_stage4.doc Version 1.30 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) 1,,3 and 5. People are provided with information about what the home offers to provide. The information gathered about people is insufficient to ensure that their needs will be met. EVIDENCE: The statement of purpose and service user’s guide are made available to current and prospective service users and or their families. There is information about what services and facilities provided and the care service users can expect to receive. It informs people that their needs will be assessed prior to admission and information about how to make complaints. Prospective service users are invited to visit the home to look at the accommodation and to meet with the staff and service users already living in the home. The majority of service users for whom the service is intended are not always able to make an informed choice about moving into the home. They depend on
Glencoe J53_J04_S44875_Glencoe_V226988_250505_stage4.doc Version 1.30 Page 9 either their families and/or care managers to support them in making the decision to move into the home or make the decision on their behalf. The home provides personal care and accommodation for people with dementia. The current assessment form in use does not give sufficient scope to gather and record all aspects of service users physical health care needs, mental health care needs and any challenging behaviour that may be associated with dementia. Before any admission is agreed there must be information to show that the service users needs have been fully assessed by staff from the home, that staff have the training and skills to meet the assessed needs and that the admission has been agreed with the service users and or their representatives. Glencoe J53_J04_S44875_Glencoe_V226988_250505_stage4.doc Version 1.30 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 standard(s) 7,8 and 9. There are systems in place to record the service users health care needs and information about how their care is delivered. EVIDENCE: All of the service users have an individual care plan, which gave information about their physical health care needs, a social history and contact they have with family and friends. Risk assessments had been carried out and identified where service users were at risk from falls and any problems with their mobility. There was information about the contact they had from their doctor and the district nursing service, hospital appointments and the outcomes of any treatments administered. There are systems in place for the care staff to keep records of the care they have delivered and where there have been any problems identified and details of the actions taken to manage the problems. A number of the service users need assistance with their meals and there was information about the level of help needed. Basic nutritional assessments were recorded and records were kept detailing any food supplements prescribed. There are no service users living in the home who administer their own medication. The monitored dosage medication system is in operation and the
Glencoe J53_J04_S44875_Glencoe_V226988_250505_stage4.doc Version 1.30 Page 11 records showed that the service users received their prescribed medication appropriately. All medication is kept secure and reviewed as necessary by the service users doctor. Arrangements are in place for staff to complete the required medication training. Glencoe J53_J04_S44875_Glencoe_V226988_250505_stage4.doc Version 1.30 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 standard(s) 12, 13, 14 and 15. Visiting arrangements are flexible allowing service users good and regular contact with family and friends. Meals provided are nutritious and offer a varied diet with choice from the menu. EVIDENCE: It was difficult to establish from the service users if the home matched their expectations and preferences but the majority of the service users originate from Whitby and surrounding areas. The staff live locally and can discuss with service users things that are happening in the local community, which helps keep them in touch with local current events. Information about the service users family and friends is recorded in their care plans and the details for the arrangements for visitors can be found in the service user’s guide and in the home. There were visitors in the home at the time of the inspection. The staff welcomed them and they took advantage of the good weather by sitting in the garden with their relatives. Glencoe J53_J04_S44875_Glencoe_V226988_250505_stage4.doc Version 1.30 Page 13 The lunch time arrangements were good, the tables were laid in the dining room and the majority of the service users take their meals in the dining room, staff were available to help them where needed and the atmosphere was relaxed. Some service users need help at meal times and staff were observed helping in a sensitive manner. One service user did not want the food offered and a member of staff offered alternatives and encouragement to take some form of nourishment. Glencoe J53_J04_S44875_Glencoe_V226988_250505_stage4.doc Version 1.30 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 standard(s) 16 and 18. The home has a complaints policy and procedure but all staff would benefit from abuse awareness training to ensure the service users are protected. EVIDENCE: The details of the complaints procedure are available in the statement of purpose and the service user guide. Records of all concerns and complaints are recorded including the outcomes of any investigations undertaken. The service users accommodated are not always able due to the nature of their condition to make a complaint about life in the home or about the standard of care they receive. The policies and procedure in place are set out to protect service users and to enhance this it is important that all staff undertake dementia awareness and adult protection training. All staff should be familiar with and have access to the Local Authorities policy and procedure for the protection of vulnerable adults and for the reporting of allegations and/or suspicions of abuse. A recent incident occurred in the home that affected the wellbeing of a service user, which resulted in an admission to hospital, such incidents must be reported under Regulation 37 to the Commission for Social Care Inspection without delay. Glencoe J53_J04_S44875_Glencoe_V226988_250505_stage4.doc Version 1.30 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 standard(s) 19, 20, 24, 25 and 26. Improvements are being made to the standard of the environment but a number of the required safety checks had not been carried out. EVIDENCE: The home was warm and clean and free from offensive odours. There are systems in place for the control of the spread of infection and protective clothing is provided for staff. Some bedrooms had been redecorated and plans were in place for more to be done. New carpets had been laid on the stairs and were being laid on the corridor at the time of the inspection. The service users rooms are personalised and there are locks on all the bedroom doors. The doors to the home are locked to ensure the safety of the service users they have access to the garden. The garden area has improved and now provides an attractive area with seating and shade for the service users.
Glencoe J53_J04_S44875_Glencoe_V226988_250505_stage4.doc Version 1.30 Page 16 Work to improve the kitchen has not been completed and decoration of the dining room remains outstanding. The windows on the upper floor of the home were not clean; the manager is trying to engage a window cleaner to remedy this. The records showed that the required fire risk assessment has not been completed, that the fire safety equipment was not tested on a weekly basis and the hot water temperatures were not tested as required. Action must be taken to carry out the required tests, to record the findings and details of actions taken to ensure all systems are in good order. Glencoe J53_J04_S44875_Glencoe_V226988_250505_stage4.doc Version 1.30 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 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) 27,28, 29 and 30. There are sufficient staff on duty to provide care to the service users but poor induction practice and lack of appropriate training may leave service users at risk. EVIDENCE: The staff rota showed that there were sufficient numbers of staff on duty in the home during the day and overnight and staff are employed to carryout catering and domestic duties. There were no records in place to confirm that newly appointed staff had undertaken an induction into the home its policies, procedures and care practices. Arrangements are in place for staff to either undertake or complete the following training, medication, dementia awareness, challenging behaviour, abuse awareness and NVQ. There are no staff currently working in the home who have undertaken TOPPS induction and no staff who have achieved NVQ Level 2. Glencoe J53_J04_S44875_Glencoe_V226988_250505_stage4.doc Version 1.30 Page 18 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) 31 34, 36 37 and 38. The registered manager has an understanding of the areas in which the home needs to improve. EVIDENCE: The registered manager has implemented a number of changes towards the development of the service provided in the home. No arrangements have been made for her to undertake NVQ Level 4 in management. Senior staff are employed for the purpose of taking responsibility for some of the daily routine tasks and for the running of the home when the manager is away from the home. The manager reported that the senior staff are reluctant to take this responsibility. This situation needs to be addressed to ensure that the home
Glencoe J53_J04_S44875_Glencoe_V226988_250505_stage4.doc Version 1.30 Page 19 continues to run smoothly at all times and that all required tasks are carried out. A number of the service users are helped by the staff to manage their personal money. This enables the service users to have their hair done and to buy goods from the local shops. There money is held in a safe place and there were records and receipts in place for all transactions made on their behalf. An audit of the records was carried out and whilst there were no financial discrepancies the records were not accurate. As part of the quality assurance and quality monitoring system it is important that all the homes policies, procedures and records are monitored on a regular basis. The copies of the reports on the conduct of the home as required under regulation 26 were not available at the time of the inspection. These records are important and should provide evidence that all aspects of the home the policies and procedures are monitored and reviewed, including the performance of the staff as part of the quality assurance system and as required by the regulations. The home has a health and safety policy and procedure in place but not all staff have completed the required health and safety training, where new staff have been employed it is important for the safety of the service users and there own safety to complete the required training as soon as possible. To ensure the continuing safety of the service users the requirements of the fire safety department and the environmental health department should be met in full as detailed in the text in relation to the environment. Glencoe J53_J04_S44875_Glencoe_V226988_250505_stage4.doc Version 1.30 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 1 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 1 3 x x x 3 1 x STAFFING Standard No Score 27 3 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 1 x x 1 x 1 1 1 Glencoe J53_J04_S44875_Glencoe_V226988_250505_stage4.doc Version 1.30 Page 21 YES 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 The registered person is required to implement a comprehensive assessment format that accurately records all assessed needs and confirmes that the home can meet needs as assessed. The registered person is required to make arrangements for all staff to undertake abuse awareness training, and for them to be familiar with the procedure for reporting under loacal authorities procedure. The registered person is required carryout the required checks on fire safety equipment and the temperature of hot water from all outlets and to record the findings of these checks. The registered person is required to make arrangements for the registered manager to undertake NVQ Level 4. All new staff to undertake TOPPS induction. To keep records of staff induction. To have 50 of the workforce trainined to NVQ Level 2 or equivilant. For staff to complete dementia awareness,challenging behaviour and health and safety
Version 1.30 Timescale for action 30th September 2005. 2. 18 13(6) 30th September 2005. 3. 19 and 25 and 38. 23 30th September 2005. 4. 28,30,31, 36 and 38. 18 (1)(a)( c) 30th October 2005. Glencoe J53_J04_S44875_Glencoe_V226988_250505_stage4.doc Page 22 5. 34 17 Schedule 4(9) training. To make arrangements for all staff to have formal supervision The registered person is required to keep accurate records of all financail transaction carried out on behalf of service users. 30th September 2005. 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 9 Good Practice Recommendations It is recommended that all staff competed medication training. Glencoe J53_J04_S44875_Glencoe_V226988_250505_stage4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit 4 Triune Court Monks Cross york YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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