CARE HOMES FOR OLDER PEOPLE
Handsworth Methodist Home West Road Bowdon Altrincham Cheshire WA14 2LA Lead Inspector
Val Bell Unannounced Inspection 6th December 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Handsworth Methodist Home DS0000005609.V270385.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Handsworth Methodist Home DS0000005609.V270385.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Handsworth Methodist Home Address West Road Bowdon Altrincham Cheshire WA14 2LA 0161 928 5314 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) Methodist Homes for the Aged Mr Mark Greenhalgh Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Handsworth Methodist Home DS0000005609.V270385.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. All service users will fall within the category of old age and may additionally have a physical disabilty or dementia. The six bedrooms on the 3rd floor are not used for service users who require the use of wheelchairs or those who have poor mobility. Alternative accommodation will be provided should any service users living on the 3rd floor require it in the future. A minimum of four care staff are employed between 8.00am - 2.00pm and 6.00pm - 10.00pm and overall staffing levels will not fall below the minimum requirements set out in the Residential Forum guidelines, `Care Staffing in Care Homes for Older People`. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 1st June 2005 3. 4. Date of last inspection Brief Description of the Service: Handsworth Methodist Home provides residential accommodation with personal care for up to forty-one residents within the category of old age. Handsworth is a private care home owned by Methodist Homes for the Aged. Mr Mark Greenhalgh is the registered manager. The home is a large purpose built property set in pleasant grounds that are enclosed and accessible to residents. The rear garden area has recently been landscaped with a view to meeting the sensory needs of residents. It includes a sensory area, and Japanese and English rose gardens. Lampposts and lanterns will be installed by spring 2006. The property is situated in a quiet residential area of Bowdon within easy reach of a post office, general store, church and public house. The village of Hale is a short distance away and Altrincham is the nearest main town. The home is conveniently situated for local transport services and main motorway links. The home is arranged on three floors, which are accessed by a passenger lift. All bedrooms are single and have en-suite facilities. Communal areas consist of a large dining room, several lounges, a conservatory, activities room and tea bays on each floor. Handsworth Methodist Home DS0000005609.V270385.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over two days, 6th and 8th December 2005. During the inspection conversations were held with management, care staff, domestic staff and residents. Various records including care plans were examined and a tour of the home was undertaken. Four of the six requirements made at the previous inspection had been met and a further seven requirements and one recommendation were made at this inspection. What the service does well:
Care plans were very detailed and gave clear instruction to carers regarding meeting residents identified needs. Two of the care plans that were assessed were considered to be examples of good practice. It was recommended that these be used to cascade best practice to the rest of the care team. The home received a commendation in relation to evidence of skilled observation in recognising that adaptations to taps and sink pedestals in bathrooms would maximise individual residents ability to maintain their independence. The home received a second commendation for undertaking monthly quality assurance audits that were structured in line with the National Minimum Standards for Older People. Staffing levels had been increased to include an extra carer on the morning shift. Care staff said this had been beneficial in spending more quality time with residents. Additionally, the deployment of staff teams to the three floors in the home would ensure that residents’ needs would be met more efficiently. Staff and residents confirmed that the home was well managed and that management were supportive and responsive to suggestions for improvement. The home provided a lively activity programme and residents said that this was varied and enjoyable. The homes communal areas and bedrooms were clean, well maintained and tastefully decorated and the garden had been imaginatively landscaped to provide sensory stimulation for residents. Rigorous infection control procedures were in place to ensure a hygienic environment was maintained. Robust procedures for the protection of adults from abuse were in place and these ensured that the right of people to be safe was protected. Handsworth Methodist Home DS0000005609.V270385.R01.S.doc Version 5.0 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. Handsworth Methodist Home DS0000005609.V270385.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Handsworth Methodist Home DS0000005609.V270385.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Residents could be confident that a robust assessment process would ensure that their individual needs were identified. EVIDENCE: No progress had been made on updating the Service User Guide to inform people how to obtain a copy of the most recent inspection report. However, the manager stated that he had ordered a wall mounted docket holder for the reception area to display both Service User Guide and a copy of the most recent inspection report. When this information is included in the Service User Guide the Standard will have been met. The requirement made at the previous inspection is re-iterated in this report. Since the last inspection the homes in-house assessment of need had been updated to include an assessment of residents mental health needs. Handsworth Methodist Home DS0000005609.V270385.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 10 Improvements made to the care planning system ensured that carers had clear instructions for meeting residents assessed needs. The absence of a risk assessment and management tool potentially placed the health and welfare of residents at risk. Failure to store residents’ personal information securely places individuals right to privacy and confidentiality at risk. EVIDENCE: Several care plans were assessed during the inspection. A new care plan format was being used and this was found to be an improvement on the previous system. Care plans had been developed from comprehensive assessments of need. Two of the care plans were commended as examples of best practice as they were very detailed and clear in describing the specific tasks that carers should undertake for the individual residents. A recommendation was made for these two care plans to be used to cascade best practice in care planning to the rest of the care team.
Handsworth Methodist Home DS0000005609.V270385.R01.S.doc Version 5.0 Page 10 Little progress had been made in the development of a risk assessment tool. The inspector was told that this was a corporate issue as the organisation did not have a risk assessment and risk management format. The requirement made at the previous inspection is re-iterated in this report. Care plans provided evidence that the assessed needs of residents were being met. The manager had re-organised staff teams by assigning responsibility to assistant managers to ensure that tasks, such as making residents regular drinks, were undertaken on each floor of the home. This means that the meeting of residents’ needs can be managed more efficiently. During a tour of the premises the inspector found a communication book used by domestic staff on a table in the reception area. The communication book contained confidential information relating to individual residents. A requirement was made accordingly. Handsworth Methodist Home DS0000005609.V270385.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 A lively activity programme provided residents with stimulation and interest. Failure to keep food storage areas clean and inappropriate storage of food potentially places the health and welfare of residents at risk. EVIDENCE: The homes notice board detailed the Christmas activities that were being provided by the home from 2nd December to 23rd December 2005. The homes weekly activity schedule was discussed with the activities co-ordinator during the inspection. A lively programme was provided, including an exercise class and visiting entertainers. Residents were attending a salt-dough workshop on the morning of the inspection. The home produced two menu formats; one displayed in a presentation holder outside the dining room and menu’s were available in large print. A discussion with a group of four residents revealed that two of those residents did not realise that alternative meals were always available. Further discussion revealed that three of the residents found the cooked meals to be too salty. Additionally, it was not clear if residents understood that a choice of snacks and drinks were available at suppertime. A requirement was made for the registered manager to discuss these issues and clarify the choices available to
Handsworth Methodist Home DS0000005609.V270385.R01.S.doc Version 5.0 Page 12 residents at their forthcoming meeting. Menus must also be updated to reflect this information. The kitchen and food stores were assessed during this inspection. The kitchen area was found to be generally clean although the dry food store showed evidence of dust and cobwebs on a windowsill behind the storage shelves. There was no evidence that regular cleaning was being undertaken, as cleaning schedules were not available. A requirement was made accordingly. The registered manager had addressed this issue by the second day of the inspection. Dried food was being appropriately stored, however beef burgers and sausages stored in a freezer were not date labelled. Fridge and freezer temperatures had been recorded daily. The inspector was told that the kitchen was scheduled for a full refurbishment during 2006/07. Handsworth Methodist Home DS0000005609.V270385.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Residents were confident that their concerns would be listened to and that action would be taken to put things right. Failure to undertake a risk assessment for a newly admitted resident who had chosen to manage her own finances potentially placed her welfare at risk. EVIDENCE: Since the last inspection the home had improved the complaints recording system. This now complied with the requirements of the Data Protection Act 1989. All residents spoken to confirmed that staff listened to their concerns and that action would be taken to address the problem. Since the last inspection three residents had experienced cheque theft involving considerable amounts of money. The amounts stolen, had been reimbursed by the residents’ banks and appropriate measures had been taken in the home to prevent further cheque fraud. The incidents had been reported to the local authority adult protection officer and a police investigation was ongoing at the time of this inspection. The inspector spoke to two of the three residents affected. One of the residents confirmed that a relative was now managing her finances and valuables and the other resident confirmed she held a key to a lockable facility in her room. However, a resident who had been recently admitted had previously experienced financial abuse in her own home. The resident had chosen to manage her own finances. This must be risk assessed to ensure that the resident is not at risk of financial abuse while resident in the home.
Handsworth Methodist Home DS0000005609.V270385.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 26 Skilled observation and assessment practice has enabled residents to maximise their independence. EVIDENCE: The homes handyperson had been delegated responsibility for monitoring health and safety within the home. He told the inspector that he had observed that some residents experienced difficulty operating standard taps. His suggestion for improvement in this area had been to replace taps with lever operated models. He had also suggested that by removing the pedestals on washbasins access would be improved for people who use wheelchairs and the areas beneath the basins could be more hygienically maintained. These improvements have been taken on board by the home. This is considered to be an area of best practice in promoting the independence and welfare of residents and the home received a commendation. On a tour of the home the environment was found to be well maintained, pleasantly decorated, generally clean and hygienic and no unpleasant odours were detected.
Handsworth Methodist Home DS0000005609.V270385.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29 Residents were being cared for by a trained and regularly supervised team of carers who consistently made sure that residents’ needs were being met. The practice of not obtaining up to date CRB certificates for newly recruited staff potentially places residents at risk. EVIDENCE: The home was adequately staffed on the day of inspection. In conversation with staff it was confirmed that an additional member of care staff had been deployed and this had resulted in staff spending more quality time on personal care tasks. The registered manager stated that a further increase in staffing resources had been included in the 2006/07 budget. The two volunteers who needed Criminal Record Bureau (CRB) checks at the time of the last inspection had since resigned. However, in conversation with the inspector the registered manager stated that in recruiting new staff CRB certificates up to three months old would be accepted. A requirement was made for up to date CRB certificates to be obtained for newly recruited staff prior to confirming them in post. Handsworth Methodist Home DS0000005609.V270385.R01.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38 Apart from a few shortfalls that are detailed elsewhere in this report the home was being well managed and care staff appeared to be receiving the necessary support from management. This resulted in a consistent service for people living in the home. EVIDENCE: In conversation with the inspector several care staff confirmed that the home was being well managed. One member of staff said, ’the manager is very supportive and you can always approach him for help and guidance.’ Another carer said, ‘the assistant managers help out on the floor and the situation has been much better since putting an extra carer on the early shift.’ Staff also confirmed that they had been offered regular supervision and supervision records were made available to the inspector. A carer told the inspector, “training needs are discussed in supervision and management will always do their best to find suitable training for you. It’s sometimes frustrating because
Handsworth Methodist Home DS0000005609.V270385.R01.S.doc Version 5.0 Page 17 we can miss training because of our shifts, but mop-up sessions are arranged to overcome this.” Residents spoken to during the inspection also felt that the home was well managed and that improvements to the quality of service had been made. The registered manager showed the inspector a questionnaire that had been developed for consultation with residents regarding the future arrangements for the breakfast routine. It was encouraging to note that residents will be given the choice of taking their breakfast in their bedroom, the dining room or the tea bay located on the floor where they resided. Comprehensive quality audits of procedures within the home were being carried out on a monthly basis. These were structured in line with the National Minimum Standards for Older People. This was considered to be an area of best practice and the home received a commendation. The inspector had conversations with domestic staff on duty on the day of inspection. They told the inspector that they had achieved NVQ1 but that they felt undervalued because they had expected a pay rise following their NVQ qualification. In discussion with the manager it was explained that a pay rise would be awarded as the capital for this had been built into the 2006/07 budget. The manager said he would clarify the situation with the staff concerned. Dismantled furniture was found to have been stored next to a corridors fire door. The inspector was told that this was awaiting disposal. A requirement was made that corridors and fire doors must be kept clear of obstructions and combustible material to effect safe escape routes in the event of a fire. A requirement was made accordingly. The furniture had been removed by the second day of this inspection. Since the last inspection all staff had been reminded of the importance of ensuring that all hazardous substances are stored securely. Stringent infection control procedures were in place at the home and staff confirmed that they had received training in this area and supplies of personal protection equipment were always available. Handsworth Methodist Home DS0000005609.V270385.R01.S.doc Version 5.0 Page 18 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 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X X X 4 X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 4 X X 3 X 2 Handsworth Methodist Home DS0000005609.V270385.R01.S.doc Version 5.0 Page 19 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 OP1 Regulation 5 Requirement The Service User Guide must be reviewed and updated to include a reference informing individuals that they can access the most recent copy of the homes inspection report. Previous timescale of 01/09/05 not met. The registered person must develop and implement a risk assessment and risk management tool. Previous requirement timescale of 01/09/05 not met. The registered person must ensure that residents personal information is held securely in their individual care plans. The registered person must ensure that residents personal information is held securely in their individual care plans. Timescale for action 06/02/06 2 OP7 13 (4) 06/02/06 3 OP10 17 (1) (b) 06/02/06 Handsworth Methodist Home DS0000005609.V270385.R01.S.doc Version 5.0 Page 20 4 OP15 13 (4) 5 OP15 13 (4) 6 OP15 13 (4) 7 OP18 12(1) 8 9 OP29 OP38 19 13 (4) The registered person must consult residents to clarify that they are aware that choices and alternatives to the food and drink provided at the home are always available. This must also be made clear by including this information on the menu’s that are displayed within the home. The windowsill in the dry food store must be kept clean and cleaning schedules for the kitchen and food storage areas must be made available for inspection by officers of the Commission. All food stored in the home must be date labelled to allow for stock rotation with the use by dates. The registered manager must ensure that a risk assessment is undertaken for the resident who has chosen to manage her own finances following admission. Up to date CRB certificates must be obtained prior to confirming newly recruited staff in post. The registered person must ensure that fire escape routes and fire doors are kept clear of obstructions and combustible materials at all times. 06/02/06 06/02/06 06/02/06 06/02/06 06/02/06 06/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The two care plans, identified, as examples of best practice, should be used to cascade quality care planning to the rest of the care team. Handsworth Methodist Home DS0000005609.V270385.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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