CARE HOMES FOR OLDER PEOPLE
Glendon House 2 Carr Lane Overstrand Cromer NR27 0PS Lead Inspector
Ann Catterick Unannounced 17th June 2005 05:30 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. Glendon House I55 s27384 Glendon House v233030 (un) 230605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Glendon House Address 2 Carr Lane Overstrand Cromer Norfolk NR27 0PS 01263 578173 01263 579164 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) Mr Rhoderick Smart and Mrs Frances Smart Vacancy Care Home 36 Category(ies) of Dementia - over 65 years of age (36), registration, with number Old age, not falling within any other category of places (36) Glendon House I55 s27384 Glendon House v233030 (un) 230605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Thirty-six (36) Older People may be accommodated. 2. Thirty-six (36) people with dementia may be accommodated. 3. The total number not to exceed thirty-six (36). Date of last inspection 01 February 2005 Brief Description of the Service: Glendon House is a care home providing care and accommodation for 36 older people who are suffering from dementia. Mr Rhoderick Smart and Mrs Frances Smart own the home. There is no registered manager at the present time and Lee Ridgewell who is the assistant manager is receiving support in the management of the home from Lisa Rutter (a registered manager in another care home in the same group). The original house was built in 1917, and has been tastefully extended and adapted over the years. The most recent refurbishment has included creating 11 new bedrooms, all en suite, and a heated conservatory and new office. The kitchen has now been refurbished. The home has 30 single bedrooms and 3 double rooms. Twenty-eight of the single rooms have en suite facilities and all of the double rooms have en suite facilities. A large part of the grounds has been made into a safe and secure garden area for service users. The home provides comfortable good quality accommodation in an attractive setting in a small coastal village, being very close to the sea. Glendon House I55 s27384 Glendon House v233030 (un) 230605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place a 6am on the morning of the 17th of June. Due to the time of the inspection many of the standards were not looked at on this occasion but will be looked at in future inspection. The inspector was able to talk with night staff and the staff that came on duty for the morning shift as well as observe the change over meeting between day and night staff. The inspector was able to visit the kitchen and speak with the cook and kitchen assistant. The inspector was able to meet with and speak to several service users, some of whom were up when she arrived and others who got up later during the morning The inspector was able to look at some care plans, the incident and accident records, and the rota. In conclusion those service users seen appeared to be being well cared for and the relationship between staff and service users was good. However the proprietor does need to ensure there are sufficient numbers of staff on duty at all times, including night time. What the service does well:
Due to the mental frailty of service users it was sometimes difficult to assess whether or not they were satisfied with the care provided. However on the day of inspection all of those staff seen working with service users carried out their duties in a kind and caring way having a good relationship with the people they were caring for. No service user is able to administer their own medication and the administration of breakfast medication was observed. The senior member of staff on duty ensured that medication was stored safely, did not secondary dispense and took a glass or orange to each service user as she gave them their medication. Most importantly she remained with the service user until she was sure that they had taken their medication.
Glendon House I55 s27384 Glendon House v233030 (un) 230605 Stage 4.doc Version 1.30 Page 6 All of those staff spoken to, except for the new member of staff, were aware of what to do in the event of a fire and had received training in this area. What has improved since the last inspection? What they could do better:
There was not the right level of experienced staff on duty for the night time shift and the home needs to ensure that three night staff are on duty at all times and if any new staff are on duty they should be additional to the rota for the first shifts that they work as this should be part of their induction to the post. Insulin was seen in the kitchen fridge and this is the incorrect way to store it. The insulin needs to be stored in a fridge that is specifically for this purpose and kept in a safe place away from the general kitchen. A radiator within a thoroughfare near the downstairs office is not covered and was hot on the day of inspection. This radiator needs to be covered or change to a low surface temperature radiator. All of the service users that live at Glendon House are suffering from dementia and it would be seen as good practice for staff to receive regular training in this area. It would be seen as good practice for the provider to have some of the varied and plentiful publications within the home for staff to use within training and as a general information library. It was disappointing to find that the activities person is now working as kitchen assistant and is likely to be doing this for several weeks. A better solution would be to employ a new kitchen assistant.
Glendon House I55 s27384 Glendon House v233030 (un) 230605 Stage 4.doc Version 1.30 Page 7 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. Glendon House I55 s27384 Glendon House v233030 (un) 230605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Glendon House I55 s27384 Glendon House v233030 (un) 230605 Stage 4.doc Version 1.30 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 standard(s) 0 None of the outcomes for these standards were inspected on this occasion. . EVIDENCE: Glendon House I55 s27384 Glendon House v233030 (un) 230605 Stage 4.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 and 9 A sample of care plans were seen and it was found that some of the information had not been reviewed and therefore not all care plans included the correct and updated information needed. The homes policy and procedures with regard dealing with medication appeared, mostly, to be promoting the safety and well being of service users. EVIDENCE: Glendon House I55 s27384 Glendon House v233030 (un) 230605 Stage 4.doc Version 1.30 Page 11 Some care plans were looked at and it was noted that some of the information about service users had not been reviewed and was therefore incorrect. Without regular review the purpose of care plans is diminished. For example some of those service users that were up at 6am had later times for their preference for rising indicated within their care plans. It was suggested that their needs had changed but this not been amended in their care plans. The administration of morning medication was observed and this was administered in a way that showed good practice and competence by the senior carer. The senior carer gave each service user a drink with their medication and waited with them to ensure and encourage the administration of their medication. Insulin was stored in the kitchen fridge and this does not promote the safety of service users and therefore is not deemed good practice. In a home of this size there would be an expectation that insulin, or any other medication that needed to be stored in a fridge, be stored in a fridge provided specifically for this purpose and that it is in a secure area such as a medical room or office. Glendon House I55 s27384 Glendon House v233030 (un) 230605 Stage 4.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 and 15 Those service users spoken to appeared to be satisfied with the lifestyle experienced within the home at the time of the inspection. For some of those service users seen some of their preferred preferences were different to what was written their care plans. Service users were seen to have breakfast and this was provided to them at their time of rising. Menus suggested that service users receive a wholesome balanced diet. However the cook had received no training in cooking and menu planning for people with dementia. EVIDENCE: On arrival at the home the time was 6am and several service users were up in the dining area. After a short time these service users were offered tea and toast and appeared quite settled. The care plans of these service users were looked at under “preferred time of waking” different times were given between 5am and 9.30am. When this issue was discussed with the senior member of staff on duty it appeared that the care plans needed to be revised as the preferences on the care plans had changed for some of the service users as they now woke earlier and chose to wake up. The staff said that all of those service users up had chosen to get up at that time. Glendon House I55 s27384 Glendon House v233030 (un) 230605 Stage 4.doc Version 1.30 Page 13 For those service users up later breakfast was unhurried and served to service users by the kitchen assistant when they came into the dining area. Some of those who had the early morning breakfast chose to have early breakfast and a later breakfast. The kitchen was clean and appeared well managed and food seen was stored appropriately. The cook had received no training regarding providing meals for people with dementia and there were no cookery books addressing these issues. Much has been written on this subject and the inspector would expect to see some information about this in a home that provides care solely for people with dementia. Glendon House I55 s27384 Glendon House v233030 (un) 230605 Stage 4.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) 0 None of the outcomes for these standards were inspected on this occasion. EVIDENCE: Glendon House I55 s27384 Glendon House v233030 (un) 230605 Stage 4.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 and 26 The home was found to be secure at the time of the early morning inspection with the front door being locked. Those areas of the home that were seen were well maintained offering good quality accommodation that was clean and hygienic. EVIDENCE: Due to the time of the inspection not all areas of the home were seen but those areas seen were clean, tidy and well maintained. Two domestic staff were on duty on the day of inspection. The proprietor has, over the last couple of years extended and improved the property to provided good quality accommodation. Glendon House I55 s27384 Glendon House v233030 (un) 230605 Stage 4.doc Version 1.30 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 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 and 30 On the day of inspection there were not the amount of staff on duty as identified on the rota to meet need and this could affect the care provided to service users. On the day of inspection those staff seen working with the service users appeared to be competent and trained in the care of older vulnerable people. EVIDENCE: At 6 am there were only two established staff and one new member of staff on duty. It was the new member of staff’s first shift and this person should have been supernumerary to the rota and not counted as a member of staff. Staff files were appropriately locked up, however the inspector was able to speak to those staff on duty with regard the training they had received. Staff said that they had received induction and foundation training and were encourage to completed NVQ level two or three. Those observations made on the morning of the inspection confirmed that staff were competent to do their jobs. Some training had been offered relating to dementia care but this is an area that could be further developed. Glendon House I55 s27384 Glendon House v233030 (un) 230605 Stage 4.doc Version 1.30 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 and 38 The Home currently lacks the leadership provided by a permanent manager. Some areas of health and safety were inspected and the outcome in the areas did not always promote the protection of service users. EVIDENCE: Those staff spoken to spoke favourably about the assistant manager, Lee Ridgewell who has taken over the responsibility for the home with the support and guidance of Lisa Rutter who is a senior registered manager from another home owned by the provider. The home hopes to appoint into the role of manager in the near future. The new member of staff on night duty had not been given instruction about what to do in the event of a fire and this could, in the event of a fire, put service users at risk. All new staff members must be given fire instruction on the day they commence work.
Glendon House I55 s27384 Glendon House v233030 (un) 230605 Stage 4.doc Version 1.30 Page 18 In several areas of the home heating is provided by under floor heating or low surface temperature radiators. The radiator outside the downstairs office is in a service user walkway and is not covered and was very hot on the day of inspection. This radiator needs to be covered or changed to a low surface temperature radiator. An additional book had been introduced for the recording of incidents and accidents. The consequence of this was that not all staff were reporting incidents in the formal incident and accident book and just recording in the newly introduced book. The way that information was documented within the newly introduced book did not meet the requirements of data protection or the requirements for reporting incidents and accidents. Glendon House I55 s27384 Glendon House v233030 (un) 230605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x 3 x x x x 2 Glendon House I55 s27384 Glendon House v233030 (un) 230605 Stage 4.doc Version 1.30 Page 20 N/A 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. 2. Standard 9 27 Regulation 13.2 18.1a Requirement The registered provider must ensure that all medicines is stored appropriatley. The registered provider must ensure that there are competent and experienced staff on duty in such numbers as are appropriate for the health and welfare of service users. The registered provider must ensure that all staff receive suitable training in fire prevention and that this training starts of the first day of working in the home. The registered must insure that individual records are kept of any falls or accidents that happen within the home and that these meet with RIDDOR regulations and the Data Protection Act. The registered provider must ensure that those radiators that are of a hot surface temperature and in an area used by service users are risk assessed and either covered or changed to low surface temperature radiators. Timescale for action 01/07/05 20/06/05 3. 38 23.4d 20/06/05 4. 38 17.1a 01/07/05 5. 25 13.4 01/08/05 Glendon House I55 s27384 Glendon House v233030 (un) 230605 Stage 4.doc Version 1.30 Page 21 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 12 30 Good Practice Recommendations It would be seen as good practice that the activities person return to her appointed role as soon as possible and a kitchen assistant be appointed. It would be seen as good practice to ensure that all staff receive regular training that is specifically related to caring for people with dementia and have access to publications and reading material in this area. Glendon House I55 s27384 Glendon House v233030 (un) 230605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 3rd Floor - cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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