CARE HOMES FOR OLDER PEOPLE
Hafod Residential Home 14 Anchorage Road Sutton Coldfield West Midlands B74 2PR Lead Inspector
Amanda Lyndon Key Unannounced Inspection 3rd May 2007 09:50 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 Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 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. Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hafod Residential Home Address 14 Anchorage Road Sutton Coldfield West Midlands B74 2PR 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) 0121 355 6639 0121 355 5688 Hafodlimited@aol.com Mr Alan Pearce Janet Lillian Taylor Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: none Date of last inspection 19 September 2006 Brief Description of the Service: Hafod Residential Home is registered to provide personal care for sixteen people aged 65 years and above for reasons of old age. The Home does not provide nursing care and does not have a category to care for people with dementia. The Home does not accommodate people who require the use of wheelchairs and hoisting equipment is not available for general use. Accommodation is provided in a large and sympathetically adapted Victorian building situated at the junction of Anchorage Road and Lichfield Road approximately one mile from the centre of Sutton Coldfield. There are good bus links from Birmingham and Lichfield. There are 14 bedrooms, two of which are shared rooms however the Home utilises these as single rooms, and the majority have en-suite facilities. There is a call bell facility in each bedroom for residents to use in order to summon assistance or urgent help in the event of an emergency. Bedrooms are located on the ground and first floors and a passenger lift gives access to these areas. Communal areas are available on both floors, these are spacious, attractive, well appointed and in keeping with the age of the property. A conservatory leading off the ground floor lounge serves as a dining room. Assisted bathing facilities are strategically located on each floor offering a choice of bath or shower facilities, including a Jacuzzi facility and staff are available to provide assistance in these areas as required. The Home has a large enclosed and attractive rear garden. There is limited off road parking at the front of the premises. There are notice boards located throughout the Home displaying forthcoming events and other information of interest to residents and their visitors in a large print format. There is an interesting activities programme both inside and outside of the Home. The weekly fee to live at Hafod Residential Home is between £575 and £650 and physiotherapy is included within the weekly fee. Items not covered by the fee include hairdressing, private chiropody, newspapers, outings and holidays. Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Information obtained and used in the planning of this field work visit included Regulation 37 notification reports of any accidents or incidents involving people using the service and one complaint received by CSCI since the last key visit at the Home. The unannounced key field work visit referred to in this report was undertaken over one day by one Inspector when there were thirteen residents living at the Home. Information was gathered by speaking with twelve residents, a visitor, the Director, Registered Manager and all staff members on duty. Positive comments were made about the service provided at the Home. Additional methods of obtaining information included case tracking people that use the service, examining care, medication, staffing and health and safety records and observing the staff perform their duties. A partial tour of the Home was undertaken. No immediate requirements were made on the day of the visit Prior to the field work visit a self assessment was sent to the Home and this was being completed at the time of the visit in order to obtain further information about the service provided and the quality of outcomes for people using the service. What the service does well:
Prior to coming to stay at the Home people are encouraged to make informed decisions about whether they would like to live there and people are encouraged to sample what life would be like there. Residents have access to a range of Health and Social Care Professionals and staff provide support to ensure that any instructions are carried out and this ensures that any health care needs are met. One resident said “A man came to look at my feet yesterday, he was very good”. Memos and other information of interest to residents on display in the Home, are in a large print format for ease of reading for people with visual impairments. Residents are cared for in a respectful manner by staff working at the Home and this ensures that their self-esteem and dignity are maintained. Residents are able to exercise control over their daily lives and the activities that they choose or choose not to participate in and this promotes their independence and individuality. There are no rigid rules or routines.
Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 6 One resident said “We had a lovely celebration for my 99th birthday yesterday. We had a big party, everyone enjoyed themselves” Another resident said “We can go to bed at whatever time we want. We sit downstairs and have a natter” Residents are supported to continue to practice their chosen religions whilst living at the Home and this ensures that their beliefs and individuality are respected. Visitors are made to feel welcome and a good rapport had built up between people using the service, staff and their visitors. One visitor said “It is so nice here, there are no visiting restrictions, we are always welcome here” There is a choice of wholesome meals which meet any dietary needs for reasons of health, taste, culture or religion. One resident said “If you ask for food one day and it’s not on the menu, you can bet your life that the food is given you the next day, it’s great” Residents and their representatives are confident that their views are listened to and any suggestions put forward are acted upon for the benefits of the residents living at the Home. Hafod Residential Home provides residents with a clean, comfortable and homely living environment in which they are safe and secure and their privacy is respected. Residents are encouraged to personalise their bedrooms to reflect their individual tastes, age, gender and culture so that they feel comfortable in their surroundings. One resident said “ I am happy with my room” Another resident said “When the sun is out there is always someone sitting out and enjoying the garden” Aids and adaptations are provided so that the independence, choice and dignity of residents is promoted whilst maintaining their safety. Regular maintenance checks of this equipment ensure that they are safe to use. Staff training is provided so that staff had the opportunity to gain the appropriate knowledge to work safely and effectively and provide a good standard of care for residents living at the Home. Residents and staff expressed their satisfaction about the current staffing levels. One resident said “There are always staff when I need them, I feel safe here” Residents and their families are encouraged to put forward their suggestions about the service provided at group meetings and a suggestions book is available within the Home. Residents have the option of using the Home’s facility for the safekeeping of small amounts of money. What has improved since the last inspection? Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 7 Staff had received training about the protection of vulnerable adults and this safeguards the residents living at the Home. There is a rolling programme of redecoration and refurbishment in place so that residents are provided with an attractive and comfortable place in which to live. Since the last visit new curtains had been hung in the first floor lounge, the dining room floor had been replaced and a marine tank had been purchased following a request made by residents. Staff meetings are held regularly so that they have the opportunity to put forward their views and suggestions about the services provided for residents. The Registered Manager has been successful in registering with CSCI and has recently completed the Registered Managers’ Award. This is to ensure that she has the appropriate skills and knowledge to lead the staff team effectively for the benefit of the residents living at the Home. What they could do better:
The most recent CSCI inspection report was not accessible to residents and their visitors. Pre admission assessments must be recorded in more detail to ensure that residents’ needs could be met whilst living at the Home and to prevent residents from coming to stay there outside of the Home’s category of registration. Residents must not be admitted outside of the Home’s category of registration or as detailed within the services provided within the statement of purpose as this may prevent their care needs from being met whilst living there. Residents must be invited to and involved in care reviews so that they have the opportunity to put forward their views about whether they would like to continue to live at the Home following their trial period and at regular intervals thereafter. Care plans require further development to identify the specific support required by staff and must be reviewed with the involvement of residents so that their individual care needs are met and their preferred routines are maintained whilst living at the Home. Arrangements should be made for staff to undertake training about care planning so that they have the opportunity to gain knowledge and understanding in this area. A number of improvements are required in respect of the administration of medication so that residents receive their medication in a safe manner as prescribed. A written record of food temperatures must be kept in order to ensure that food is served to residents at the correct temperature. The portions of pureed
Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 8 diets should be served separately to enable residents to exercise control over what they are eating. The complaints procedure must be updated to identify the change in Registered Manager so that residents and their visitors have all relevant information required to make a complaint. The adult protection policy must be reviewed and include the telephone numbers of the people who must be contacted in the event of alleged or actual abuse so that residents are safeguarded. An induction check list should be devised for agency staff in order to ensure that they are aware of their responsibilities whilst working at the Home in order to maintain the health and safety of residents. A system for formally reviewing the quality of service provided for residents must be implemented in order to continually improve the care provided at the Home. Accident records should include detail of the outcomes of accidents so that audit trails could be maintained and measures could be put in place to minimise the risks of further incidents of the same. 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. The summary of this inspection report can be made available in other formats on request. Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 9 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 Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Inadequate pre admission assessments may result in individual care needs not being met whilst living at the Home. Prospective residents are able to make informed decisions about whether they would like to live at the Home. EVIDENCE: The Organisation had produced a statement of purpose and this identified that they were unable to accommodate people that used a wheelchair on a daily basis. A service user guide had been produced and this was available in residents’ bedrooms for easy access to the information included. These documents are available in a large print format to enable ease of reading for people with poor eye sight. Prospective residents are encouraged to spend time at the Home in order to sample what life would be like to live there. During this time a pre admission assessment is undertaken however the assessment tool used for this did not contain all information identified by National Minimum Standards and this may prevent a full assessment of care needs from being undertaken. The pre
Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 11 admission assessment pertaining to one resident who had recently come to live at the Home stated that this person had dementia and medication was prescribed for this. Although the Registered Manager confirmed that this person had settled in to life at the Home, Hafod Residential Home does not have a category of registration for dementia care. Two residents had developed dementia whilst living at the Home and their care needs were still being met whilst living there. The atmosphere within the Home on the day of the visit was calm and relaxed and it was apparent that all residents enjoyed living there. People come to stay at the Home on a one month trial period and the Registered Manager stated that after this time a care review is undertaken so that residents, their representatives and staff have the opportunity to discuss whether their care needs are being met. There was however, no written evidence that care reviews are undertaken and the Registered Manager stated that the review might be during a telephone call. A formal system for care reviews must be implemented including annual care reviews so that residents receive a good standard of care based on their care needs. There was, however evidence that reassessments of residents’ care needs are undertaken should their physical or mental health deteriorate and one resident had recently been transferred to a nursing home as their needs were no longer being met at the Home. Intermediate care is not provided at Hafod Residential Home Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health provision and care delivery are generally good however inconsistencies in the detail recorded in care plans and the evaluation of these may prevent the preferred routines of residents from being maintained. A number of poor medication practices may prevent residents from receiving their medication as prescribed. Residents are cared for in a respectful manner by staff working at the Home and this ensures that their self-esteem and dignity are maintained. EVIDENCE: Residents and visitors met during the visit expressed their satisfaction about the care and support received at the Home regarding their personal and health care needs. Staff met during the visit had good knowledge about residents’ individual care needs and preferences in respect of their daily lives. Residents had been supported to choose clothing, jewellery and make- up appropriate for their age, gender, culture and time of year and this ensures that their personal identity and individuality is respected.
Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 13 There was, however improvements required in respect of the use of the care planning systems and staff training in this area is recommended. The Registered Manager was keen to improve the quality of the recording on the care plans. On admission to the Home assessments of residents’ care needs are undertaken and these focus predominantly on their physical health/medical care needs and there was little information about their social care needs and preferences in respect of their daily lives. As a consequence of this the assessment does not reflect the preferred routines of individual residents and the care plans that are derived from this information are not always person focused. Care plans had been written for each resident staying at the Home. This is an individual plan of care needs and the support required by staff to meet these needs. The care plan system used at the Home was the same as that used at the nursing home owned by the Organisation however they had not been adapted to reflect the personal and social care needs of residents receiving residential care. Generic care plans were used and a number of these had not been individualised and this may prevent person centred care from being provided at the Home. A number of care plans were hand written and these included some good information about support required by staff however these also require further development to identify residents’ individual preferences and the specific support required by staff in these areas. It was identified that one resident had memory loss however a care plan had not been written about this and this may prevent staff from supporting her appropriately and effectively in this area. A care plan written about incontinence did not reflect the support required by staff regarding the management of this and care plans for specific health concerns were not always written. Care plans were not written and reviewed with the involvement of residents and their families and this is important to ensure that residents’ preferences in respect of their daily lives are maintained whilst living at the Home. Care plan evaluations were poor stating “same as above, no change” and there was no evidence that the actual support being provided in respect of each care need was being reviewed. Daily reports included good detail about the activities that residents had participated in and the condition of their physical and emotional health. Personal risk assessments had been undertaken so that residents were supported to lead safe and fulfilling lives based on their individual abilities. Residents have access to a range of health professionals including community nurses, continence advisors, physiotherapy and opticians. Residents can choose to retain their own general practitioner on admission to the Home (if the GP is in agreement). One resident said “A man came to look at my feet yesterday, he was very good” Staff are proactive and weigh residents regularly to ensure that they are not gaining or losing weight and medical advice is sought in the event of any concerns in this area.
Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 14 English is the first language of all people using the service and none of the residents had complex communication needs. A number of residents had poor eyesight and any written information of interest to these people was available in a large print format for ease of reading. Systems in place for the ordering of medication were good however not all medication administration charts (MAR) were well maintained. There were a number of gaps on MAR charts as the reasons for medication being omitted were not always recorded, the actual dose administered in respect of variable doses were not always recorded and signatures were not always obtained as confirmation of medicines received in to the Home. This will prevent an accurate audit trail from being maintained. The Registered Manager stated that she randomly audits the medication system however there were no written records to confirm this. A comprehensive audit tool was available and should be implemented at the Home in order to monitor staff competence in this area. None of the residents currently living at the Home had chosen to administer their own medication however there is an opportunity for people to do this should they choose. A number of medicine administration instructions stated “use as directed” and this may result in administration errors. The medication reference book available at the Home was dated September 2003 and it is recommended that an updated version be obtained so that staff can access to up to date information about treatments prescribed. One new staff member who was responsible for the administration of medication had not had training about this. A risk assessment must be undertaken about her competence in this area until she receives appropriate training in order to safe guard residents. Residents have the option of having a key for their bedroom doors and one resident had chosen to hold this. Most residents had a private telephone line in their bedrooms so that they could make or receive calls in private. During the visit staff were caring for residents in a respectful manner and this ensures that their dignity and self-esteem are maintained. The preferred names that residents choose to be called were not always recorded within the care plans however staff and residents confirmed that any preferences regarding this were respected. Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The activities on offer meet the needs, interests and expectations of people using the service. Residents exercise control over their daily lives so that their independence and individuality are maintained. People who use this service have a choice of healthy meals that meet any dietary requirements for reasons of health, taste, culture or religion. EVIDENCE: There are a number of in-house activities for residents to participate in should they choose including beauty treatments, movement to music, card games and video evenings. One resident said “I have had a facial today, you couldn’t ask for better” Another resident said “We had a lovely celebration for my 99th birthday yesterday. We had a big party, everyone enjoyed themselves” There were a number of trips outside of the Home for residents to participate in should they choose including regular trips to the theatre and pub lunches. A number of residents are going on holiday next month and they stated that they were really looking forward to this. One resident said “I am looking forward to the trip to Weston, it is something different to do”
Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 16 There are no rigid rules and routines at the Home and residents can go outside of the Home with their friends and family as they choose. One resident said “I’m going out with my daughter for lunch today” Another resident said “If I am out in the evening I like to be back by 10pm, that’s my choice. It is very important to me to keep contact with my friends” There was an open visiting policy and people using the service had the opportunity to meet with their visitors in private if they preferred. One visitor said “It is so nice here, there are no visiting restrictions, we are always welcome here” Residents confirmed that they could choose the times that they go to bed at night and get up in the mornings. One resident said “We can go to bed at whatever time we want. We sit downstairs and have a natter” Another resident said “I have made friends here” Opportunities for worship for people of all faiths could be arranged and Holy Communion is held at the Home each month. None of the residents choose to go to church and none of the people currently using the service were of a non Christian faith. During week- days, the main meals were prepared at the nearby nursing home run and managed by the Organisation and were transported to the Home. It was identified during a recent environmental health visit that improvements were required in respect of the monitoring of the temperature of the hot food served. On the day of the visit the staff had stated that they had taken the temperature of the lunch prior to it being served to residents however a written record of this was not available. A cooked breakfast is available and a snack meal is available at suppertime and during the night so residents are not hungry. Menus identified a choice of nutritious meals that reflected the cultural preferences of residents living at the Home. Special diets could be catered for reasons of health, religion or taste and alternatives to the main meal options were always available. The main meal option for lunch on the day of the field work visit was lamb chops with vegetables and bread and butter pudding or yoghurt for dessert. All residents had chosen to have this however alternatives to this were also available. Lunch was served hot and residents spoken with confirmed that it was tasty. One resident had a pureed diet and it was disappointing that the portions of this were mixed together and was unappetising. Being served their meal in this way does not uphold their choice or dignity. Sherry or a cold drink was served with lunch and appropriate music was being played so that the meal was an enjoyable social event. None of the people living at the Home required feeding aids however appropriate equipment could be obtained if required. One resident said “If you ask for food one day and it’s not on the menu, you can bet your life that the food is given you the next day, it’s great” Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure is accessible to people using the service and their visitors and people using the service are generally confident that their views are listened to. There are systems in place that should protect residents from harm however the lack of local agency guidelines may prevent relevant authorities from being informed of adult protection issues. EVIDENCE: Since the last field work visit CSCI had received one complaint about a response received from the Home following their investigation about an accident involving a resident who had previously stayed there. This was brought to the attention of the Organisation and Social Care and Health and work practices had been reviewed as a result of this. A copy of the investigation was not kept at the Home and this is required by regulations. The complaints procedure was on display in a large print format so that it was easily accessible to residents and their visitors and this required amendment to identify the change in Registered Manager. A “comment book” was available in the reception area of the Home so that residents and their visitors could put forward their views about the service provided. Residents and visitors met during the visit stated that that they felt confident that any concerns that they may raise would be acted on appropriately and in a timely fashion. A number of “thank you” letters had been received. Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 18 Staff had undertaken recent training about the protection of vulnerable adults so that they had the knowledge about how to recognise forms of abuse and their duty of care regarding this. The adult protection policy was due to be reviewed and local multi agency guidelines were not available at the Home on the day of the visit. This may prevent staff from notifying all relevant authorities in the event of alleged or actual abuse. Staff had, however followed the correct procedures in respect of a recent incident of a possible adult protection nature. Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are provided with a homely, clean and comfortable environment in which they feel safe and secure and their privacy is maintained. Residents are confident that any suggestions put forward about their living environment are acted upon. Aids and adaptations provided are fit for purpose and the needs of people using the service. EVIDENCE: The internal environment of the Home was homely in style, comfortable and decorated to a good standard. There was a rolling programme of redecoration and refurbishment in place and since the last visit there were new curtains in the first floor lounge and the dining room floor had been replaced. A marine tank had recently been purchased following a request made by residents and this was an interesting focal point in the ground floor lounge. Residents had the choice of two lounges, one on each floor and both were attractively decorated to a high standard. A large screen television had
Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 20 recently been purchased for residents’ enjoyment. One resident said “You can decide where you want to sit”. There was also an attractive and comfortable dining area within a well lit conservatory overlooking the garden. The garden was spacious, well maintained and was split over two levels with ramped access to the lawn area however residents had to negotiate a small step into the garden area. Residents are encouraged to participate in gardening and the planting of hanging baskets and flower tubs. One resident said “When the sun is out there is always someone sitting out and enjoying the garden” Bathrooms were decorated in a homely style so that people using the facility could do so in comfort. There were a number of aids and adaptations provided that were fit for purpose and suitable for the needs of the residents at the Home. A number of residents had been assessed for walking aids so that their independence was promoted whilst maintaining their safety. Raised toilet seats, grab rails near to toilets and hand rails in corridors were provided. There was an assisted bath and shower facility so that people with physical disabilities could use these facilities safely and in comfort. Two residents had been assessed as being at risk of developing sore skin and appropriate pressure relieving mattresses had been obtained for them. The Home chooses not to accommodate people that require a hoist to transfer and this is reflected in the statement of purpose. An exception to this is that there is one person living at the Home who requires the use of a hoist. This person’s care needs have not changed for a long period of time and the management team stated that her care needs are being met at the Home. This hoist is not used for other people and is serviced to ensure that it is safe to use. Staff had received training in this area so that they are competent to use it safely. Residents are encouraged to personalise their bedrooms to reflect their individual tastes, age, gender and culture so that they were comfortable within their surroundings. One resident said “ I have just moved room, come and look at it, it is so beautiful it takes your breath away. It has got a wonderful view. I chose this room” A lockable facility and call bell facility is provided in each bedroom for residents’ privacy and safety. The Home was found to be clean and fresh on the day of the visit with the exception that there were no hand paper towels in the ground floor bathroom and the cat had defecated on the carpet outside a residents’ bedroom and this may result in the spread of infection at the Home. The Registered Manager stated that she would replace the hand towels without delay. One resident said “The cleaners are very good” An independent infection control audit was scheduled for the near future and specialist advice was being sought about the installation of a mechanical commode pot washer for the hygienic cleaning of these. Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service receive support from an adequate number of appropriately trained and recruited staff. EVIDENCE: Staffing rotas identified that there were three staff members, including a senior carer on duty during mornings, three staff members including a senior carer and a housekeeper during afternoons and one waking staff member with sleep in support during the night. The Registered Manager provided on call support to the person in charge of the shift. The Registered Manager and staff team stated that the current staffing levels met the needs of the residents currently living there. One resident said “There are always staff when I need them, I feel safe here” Another resident said “The staff are very approachable” Staff morale is good and staff turnover is low and this ensures continuity of care for residents. One staff member said “It’s good team work here, we help each other out and get everything done”. The culture mix of staff members on the day of the visit reflected the culture mix of residents living at the Home. Agency staff are used from time to time in order to cover periods of staff sickness and holidays so that residents are supported by an adequate number of staff. The Registered Manager tries to ensure that the same agency staff members work at the Home in order to promote continuity of care for
Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 22 residents. It is recommended that an induction check list for agency staff is devised to ensure that all agency staff are aware of their responsibilities whilst working at the Home in order to maintain the health and safety of residents. Staff recruitment files contained all information required by regulations and all staff were deemed to be safe to work with vulnerable adults. New staff undertake comprehensive induction training so that they gain the appropriate knowledge to work safely and effectively. A new worker on duty during the visit confirmed that she was currently working through this. Staff had undertaken recent training about fire safety, moving and handling, food hygiene, first aid, infection control, nutrition, sore skin prevention, continence promotion, dealing with complaints, dementia and death and dying. A fire drill had been undertaken recently so that all staff had the knowledge to be able to act effectively and safely in the event of an emergency. 56 of staff had achieved NVQ level 2 in care and a number of staff were working towards NVQ level 3 and this ensures that staff have the necessary skills to provide a good standard of care. Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home is run in the best interests of the people using the service and there are some systems in place for consulting with residents and staff about the services provided there. Arrangements in place for health and safety generally protect the residents living at the Home. EVIDENCE: The Registered Manager has been in post for the last six months and has recently completed the Registered Managers’ Award so that she has the appropriate skills to lead the rest of the staff team. One resident said “The Manager is very good and encourages me to be involved here”. Another resident said “The Manager makes sure that everyone gets what they want”
Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 24 “Residents’ meetings are held regularly and the minutes of these are distributed to residents in a large print format. Topics discussed during the last meeting included menus, gardening and other activities that may be of interest to people using the service. There was evidence that requests made by residents in respect of their lives at the Home were acted upon without delay. Staff meetings are held regularly and the minutes of the most recent meeting were available. This is an opportunity for staff to be introduced to new policies and procedures, training opportunities and services provided for residents. Formal quality assurance had been not been undertaken at the Home since November 2005 and this will prevent areas of improvement regarding the service provided from being identified. The Registered Manager has recently devised a service satisfaction questionnaire and arrangements were in place for this to be distributed to residents and their representatives in order to obtain their views about the services provided at the Home. A locked facility was provided for the safe keeping of small amounts of residents’ money and written records about this were well maintained. Receipts of all items purchased out of residents’ money were kept and it is recommended that these be numbered for ease of auditing. Money balances sampled during the visit were found to be correct. Maintenance checks on equipment are undertaken regularly to ensure that they are safe to use. Accident records were generally well maintained and there was evidence that medical advice is sought as appropriate following accidents involving residents. Accident records should include detail of the outcomes of accident so that an audit trail can be maintained and measures can be put in place to minimise the risks of further incidents of the same nature. One accident record identified that a resident had sustained a “burn” on her chest and the Director was investigating the cause of this. CSCI had not been informed of the incident as per regulation 37. Following the visit CSCI were informed that health care professionals had stated that the blister may be due to a skin condition instead of an injury and a report of the findings of the investigation must be sent to CSCI. A risk assessment had been completed in respect of this to reduce the risk of further injury if the blister was due to a scalding injury. One bedroom door had been wedged open and this may result in the spread of fire. The Director stated that she would arrange for a suitable door closure to be fitted that would be activated in the event of an emergency thus prevent the spread of fire. Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 25 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 2 x 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 3 3 3 x 3 x 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x 3 x x 2 Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 26 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 OP3 Regulation 14(1) Requirement Prior to coming to live at the Home comprehensive assessments of individual care needs must be undertaken to assess whether residents’ individual care needs could be met at the Home. A robust system for undertaking care reviews must be implemented so that all people using the service have the opportunity to put forward their views about whether they would like to continue to live at the Home following the trial period and at regular intervals thereafter. All people using the service must have an up to date, detailed care plan and this must be written and reviewed with the involvement of the person using the service or their representative. This will ensure that they receive person centred support that meets their needs. (timescale of 16/11/06 not met) 4 OP9 13(2) The actual dose administered in respect of variable drug dosages must be recorded on the medication administration charts (MAR) so that an accurate audit trail can be followed 05/06/07 Timescale for action 10/06/07 2 OP5 14(2) 01/08/07 3 OP7 15 01/08/07 Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 27 Staff must sign and countersign all hand written entries on to MAR charts and all medicines as confirmation of receipt in to the Home (timescale of 16/10/06 not met) Reasons for medication being omitted must be recorded on the MAR charts so that the effectiveness of treatments can be monitored A system for the recording of medication auditing must be implemented so that staff compliance in this area can be monitored Medication must be administered following full administration instructions in order to prevent medication administration errors All staff responsible for the administration of medication must be deemed competent to do so in order to safeguard residents. 5 OP15 16(2)(j) A written record of food temperatures must be kept in order to ensure that food is served to residents at the correct temperature. A record of all complaints received and investigated must be kept at the Home as per regulations. The complaints procedure must be updated to identify the change in Registered Manager so that residents and their visitors have all relevant information required to make a complaint. The adult protection policy must be reviewed and include local multi agency guidelines and contact details so that all relevant authorities are informed about any incidents of alleged or actual abuse. A system for formally reviewing the quality of service provided for residents must be implemented and a report based on the findings of this must be made
DS0000016917.V335800.R01.S.doc Version 5.2 05/06/07 6 7 OP16 OP16 17(2) 22(1) 15/06/07 15/06/07 8 OP18 13(6) 01/07/07 9 OP33 24 31/10/07 Hafod Residential Home Page 28 10 OP38 37 11 OP38 23(4)(a) available to residents, CSCI and any other interested parties. CSCI must be informed about any incidents and accidents that affect the health or welfare of residents living at the Home. Fire doors must not be wedged open and must be fitted with self closing devices that are activated in the event of a fire in order to prevent the spread of fire throughout the Home thus safeguard residents. 05/06/07 01/07/07 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 OP7 Good Practice Recommendations Arrangements should be made for staff to undertake training about care planning so that they have the opportunity to gain knowledge and understanding in this area. The portions of pureed diets should be served separately to enable residents to exercise control over what they are eating. An infection control risk assessment should be undertaken regarding the care of the Home’s cat as the current arrangements for this may pose a risk to residents’ health. An induction check list should be devised for agency staff in order to ensure that they are aware of their responsibilities whilst working at the Home in order to maintain the health and safety of residents. Accident records should include detail of the outcomes of accidents so that audit trails could be maintained and measures could be put in place to minimise the risks of further incidents of the same. 2 3 4 OP15 OP26 OP27 5 OP38 Hafod Residential Home DS0000016917.V335800.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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