CARE HOMES FOR OLDER PEOPLE
Harry Booth House 2 Atha Crescent Beeston Leeds LS11 7BD Lead Inspector
Ann Stoner Key Unannounced Inspection 15th April 2008 09:15 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 Harry Booth House DS0000033228.V361581.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. Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Harry Booth House Address 2 Atha Crescent Beeston Leeds LS11 7BD 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) 0113 2760672 Leeds City Council Department of Social Services Mrs Michelle Haunch Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (1) of places Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th April 2007 Brief Description of the Service: Harry Booth House is located not far from Elland Road football ground and is situated off Dewsbury Road. There are a number of small shops close by and good public transport links to Leeds and Wakefield. The home can accommodate up to forty people over the age of 65 years who require personal care. Four of the forty beds are used for respite care and the home’s registration allows for one person with a disability to be accommodated. Nursing care is not provided but the home is supported by local health care services. Accommodation is over two floors, in single rooms with en-suite facilities. There is a passenger lift giving access to the first floor. Information about the service is available in the form of a statement of purpose and service user guide. These documents are reviewed regularly to make sure that the information is up to date and on request can be provided in Braille and different languages. At the time of this inspection the fees ranged from a minimum of £11. 02 per night to a maximum of £473. 60 per week. Additional charges are made for chiropody, hairdressing and toiletries. More up to date information about fees can be obtained from the home along with copies of previous inspection reports. The home has a no smoking policy. Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes
This visit was unannounced and carried out by one inspector who was at the home from 09.15 until 18.15 on the 15th April 2008. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people who live there and in accordance with requirements. Before the inspection accumulated evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the inspection visit. A number of documents were looked at during the visit and some areas of the home used by the people who lived there were visited. A good proportion of time was spent observing staff working with people. Discussions were held with people living at the home, their relatives, a visiting community nurse, as well as with members of the management team, and care staff. An Annual Quality Assurance Assessment (AQAA) had been completed by the home before the visit to provide additional information. This is a selfassessment of the service provided. Survey forms were sent out to the home before the inspection providing the opportunity for people at the home; visitors and healthcare professionals who visit the home to comment, if they wish. Information provided in this way may be shared with the provider but the source will not be identified. A small number of surveys were returned and comments are included in the body of the report. What the service does well:
There is a friendly, relaxed and informal atmosphere at the home and people are made to feel very welcome. In a returned survey a community nurse said, “I have a very good rapport with the staff at Harry Booth House. They are really friendly and helpful.” During the inspection two visitors said they particularly liked the relaxed atmosphere and that they could help themselves to tea and coffee in the small kitchenettes throughout the home. People living at the home obviously felt comfortable chatting to staff and were often seen throughout the inspection laughing and joking with them. A community nurse visiting the home described staff as being ‘fantastic’ and said that people at the home were ‘very well looked after’. Other comments made by people living at
Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 6 the home include, “We are very well looked after. My daughter can go home knowing I am OK.” “I couldn’t live anywhere better. They look after you very well.” Other comments in surveys from relatives include, “I have seen respect shown to residents on many of my visits.” “I am very happy that my mother is well cared for and is shown respect, in spite of all her problems.” People living at the home, and their visitors, have access to lots of information, most of which is displayed on notice boards throughout the home. This includes minutes of meetings, the home’s newsletter and information about forthcoming trips and outings. This makes sure that people are kept informed and consulted about any changes that are planned. The home makes sure that people without any other form of support are put in touch with an advocate from Age Concern. This makes sure that they have someone, if needed, who has their best interests at heart. Before any decisions about moving into the home are made people are invited to look round, chat to other people and sometimes offered an overnight stay. This helps to make sure that they are making the right decision and that the home can meet their needs. The home takes all complaints and grumbles seriously and makes sure that they are all recorded to show what action has been taken. Returned surveys showed that relatives were confident that if they made a complaint it would be taken seriously and acted upon. One relative said, “The staff are wonderful, always helpful and have time to listen.” People living at the home were happy with their rooms. Those that were able had keys to their rooms for added privacy. When describing her room one person said, “I love it, I wouldn’t swap it for anything.” Another person said, “The laundry always comes back nicely ironed and it is always put back in your wardrobe on a hanger.” What has improved since the last inspection? What they could do better:
The home must make sure that there is a care plan in place for people when they are admitted to the home. Without this there is no sure way of knowing that staff have accurate information on how to meet people’s needs. More
Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 7 work must be done to bring those care plans that are in place to a satisfactory standard. For example nutritional assessments and falls assessments must be completed when people are admitted to help identify those people who may be at risk in these areas. These assessments be reviewed as and when needs change. Where a risk is identified a plan must be put in place showing staff the actions they must take to reduce the risk. The review of care plans must show what information has been considered as part of the review, and wherever possible people living at the home should be included and involved in the review process. This will make sure that the home is still meeting people’s needs. Risk assessments are completed using a standard format. The result of this is that the precise level of risk to each different person is not clear and the action that staff should take to reduce the risk is not specific to each individual. The home must look at ways of personalising risk assessments to each individual so that the level of risk and any action needed is specific and relevant to each person. Domestic staff do not always wear protective aprons and gloves when cleaning toilets and when coming into contact with bodily waste. Proper infection control procedures must be followed to stop the spread of infection in the home. Any food that is liquidised should blended and served separately to make sure that the meal is appetising and that the different flavours, tastes, and textures can be identified. The home should consider using moulds that represent the food that is being served. How and when to report safeguarding issues should be discussed at senior staff meetings to make sure that everyone is aware of what constitutes safeguarding and what to do if a safeguarding issue is suspected or reported. Rotas show that there are times when there are not enough staff on duty. The layout of the building and the specific needs of people living at the home must be taken into consideration when staffing levels are determined. There must be sufficient staff on duty at all times to make sure that people are not left unsupervised and that their needs are met. A full list of requirements and recommendations made as a result of this visit can be found at the end of this report. 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.
Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 and 5. Standard 6 does not apply to this home. People who use the service experience good quality outcomes in this area. People have the information needed to choose a home that will meet their needs. We have made this judgment using available evidence including a visit to this service. EVIDENCE: There is a wide range of information available to people who currently live at the home as well as those who are thinking about moving in. In addition to the statement of purpose there is a simple guide to the home that gives people up to date information including the current fee structure. Copies of these documents were seen in the entrance area and in various lounges, along with other useful information on the many notice boards situated throughout the home. The manager said that this information is available on request in other formats, such as Braille and different languages. In the entrance to the home there is a chart with a variety of different texts written in different languages. People who cannot speak or understand the English language are
Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 10 asked to point to a language that they can understand. This helps the home identify the right interpreter to assist and support them. This is good practice. People and/or their representatives are very welcome to visit the home to help them make a decision about moving in. Two visitors said that their relative visited the home before her first respite stay. Initially she didn’t settle, so staff suggested another visit and arranged for an overnight stay to take place. This was a success and resulted in a two-week respite stay. They said that there was a noticeable improvement in her condition both during and after this stay. When a permanent admission was needed they chose Harry Booth House because the previous respite stay had been such a success. Although their relative has not been well since her admission they said that her general appearance has greatly improved and that she looks smart, tidy and well cared for. The home carries out a pre-admission assessment before any decisions about admission are made. This makes sure that the home can meet people’s needs. The assessment information for one person recently admitted to the home was sampled. Some of the information was contradictory, therefore leaving the reader unclear about the precise level of assistance and support this person needed. Care should be taken to make sure that assessment information includes accurate and specific details of the person’s needs and the precise level of support required. There was also no information about where the assessment was completed, who was involved in the process and who provided the information. This means that the home cannot evidence that the assessment process is robust and that all the relevant people have been consulted. Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 11 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): Standards 7, 8, 9 and 10. People who use the service experience adequate quality outcomes in this area. People’s health & personal care needs are met but because care records do not always reflect this there is always the risk of needs being overlooked. We have made this judgment using available evidence including a visit to this service. EVIDENCE: The care records of four people were looked at in detail, some were more detailed than others. There was some good information in one person’s records about when he preferred a bath and what he was able to do for himself. However, records showed that occasionally this person could become violent. There was nothing in his plan about any triggers to this behaviour or any instructions for staff on how to react to this type of behaviour. Another person’s plan had some excellent information such as, ‘takes pride in how she looks, likes her hair to be in place and wears make up and lipstick everyday’ ‘is able to dress herself but staff need to monitor to make sure that she has all her clothing on as she tends to forget to wear some underwear’ ‘likes to have a
Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 12 bath rather than a shower and likes to use bubble bath’. This level of recording makes sure that people are encouraged to maintain as much independence as possible and that care is personalised according to each person’s choice and needs. On the day of this inspection one person had been living at the home for just over two weeks, but there was no care plan in place for her. The General Practitioner (GP) had been notified because she was not eating and drinking in sufficient quantities but there was no nutritional assessment to identify any risks involved. Since admission she had fallen twice but no falls risk assessment had been completed. Daily records showed this person was very unsettled at night and was continually wandering into other people’s rooms. There was no information about how this was being managed. This person’s relatives said that they were aware of these issues and they felt involved, included and had been kept up to date by staff about GP visits and subsequent blood tests. Whilst there is no suggestion that this person is not receiving the correct level of care, without a care plan, that is accurate and kept up to date, there is always a risk of needs being overlooked. Care plans are reviewed each month but there was no evidence to show how the review had been carried out, who had been involved in the process or of any updates to the care plans. One person’s weight record showed that from December to April she had lost 21 lb. Evidence in the weight record showed that a dietician had been consulted in January and February. The review of the eating and drinking care plan had no information about the weight loss or of any subsequent action taken and the care plan had not been updated. This person had fallen five times from November 2007 to February 2008 but there was no prevention of falls care plan. Risk assessments were seen in care plans but these were generic and did not identify the precise risks to people or the specific action that should be taken. For example in all of the care plans sampled people had a risk assessment for choking and the action to minimise the risk was the same for everyone. One person ate a liquidised diet but this was not recorded in the risk assessment. The manager said that care plans were in the process of being updated and whilst there was evidence of this and some good recording, further work must take place to bring care records to an acceptable standard. It was clear from looking at people’s records that GPs, community nurses, chiropodists, opticians and dentists visits all visit people living at the home. A community nurse visiting the home during the inspection described the staff as being ‘fantastic’ and said that people are very well looked after. She appeared to have a relaxed professional relationship with the care officer on duty. Medication was managed properly and a small audit of controlled medication was correct.
Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 13 The home has recently distributed satisfaction surveys to people living at the home, their relatives and health care professionals. In a returned survey a community staff nurse said, “I have a very good rapport with all the staff at Harry Booth House. They are all really friendly and helpful.” A returned survey from a GP showed that he felt that people receive a high standard of care. One person living at the home said, “We are all well looked after. My daughter can go home knowing I am OK.” Another person said, “I couldn’t live anywhere better. They look after you very well.” Throughout the inspection people’s privacy and dignity was promoted and respected. In completed surveys one relative said, “I have seen respect shown to residents on many of my visits.” Another person said, “I am very happy that my mother is well cared for and is shown respect, in spite of all her problems.” Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 14 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): Standards 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. People living at the home are able to make choices about their lifestyle and have recreational activities that meet their needs. We have made this judgment using available evidence including a visit to this service. EVIDENCE: The AQAA states that a wide range of activities are provided, based on the interests of people living at the home, and an activity plan is compiled after consultation with them. Minutes of a meeting showed that people had been asked for their opinions about outings and had said that they would like fish and chip suppers, to visit local markets, and for an ice cream van to call at the home. Evidence that their views had been taken seriously was confirmed by posters throughout the home showing forthcoming activities that included a trip to a shopping centre, a visit to a large superstore and a fish and chip restaurant, a visit to a garden centre and ice cream parlour, and outings to Dewsbury market, a pub for lunch and the Middleton train museum. Planned in-house entertainment included a Hawaiian cheese and wine party with bingo, an entertainer singing show tunes from Broadway and an entertainment group called the ‘Twilight Girls’.
Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 15 People described the choices they make such as times for going to bed and getting up in the morning. One person said that sometimes he stays up after midnight but at other times he has an ‘early night’. Another person who was sitting in his bedroom listening to Classic FM said that he likes his own company and much prefers that to joining in group activities. He said that staff respect his choice. The AQAA states that people’s religious beliefs are met. One person living at the home said that he is a Jehovah’s Witness and 3 times a week he delivers leaflets and once a week he goes out to a meeting. He said that staff accepted his beliefs. The home has a visiting room where people can sit and have a private conversation with their relative without being interrupted or overheard. In a returned survey one relative said that she had used the private visiting facilities on many occasions. Other surveys showed that visitors are made to feel welcome. Two visitors confirmed this view during the inspection by saying that they liked the relaxed atmosphere and that they could help themselves to tea and coffee in the small kitchenettes throughout the home. The AQAA states that the home works closely with advocates from Age Concern and that people and their families are given information about the advocacy service. During the inspection the manager said that two people currently living at the home benefit from the support given by an advocate from this organisation. At lunchtime there were condiments on the table, and wherever possible people helped themselves from teapots, milk jugs, sugar basins, vegetable tureens and gravy boats. One carer said that this helped people to be in control of portion sizes and wherever possible retain as much independence as possible. More able people were helping those less able. There was excellent interaction between people and it was obvious that the meal time was a social occasion. There was also excellent interaction between staff and people living at the home, people were laughing and joking but when assistance was needed this was given in a discreet and sensitive way. The meal looked nutritious and appetising. A person, who did not want any of the desert choices offered, was immediately offered yoghurt by staff, when she accepted this she was then asked to choose the flavour she preferred. This person nearing the end of her meal said, “I really enjoyed that.” Another person said, “You only have to ask and staff do it for you.” The cook blended together Shepherd’s pie, vegetables, potatoes and gravy for one person who needed a soft diet. This made the meal look unappetising and left the person unable to identify or distinguish the different flavours, tastes and textures of the meal. Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 16 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): Standards 16 and 18. People who use the service experience adequate quality outcomes in this area. People are able to express their concerns and have access to a robust and effective complaints procedure. We have made this judgment using available evidence including a visit to this service. EVIDENCE: Information about how to make a complaint was available on notice boards throughout the home. People living there said that they would complain if necessary and all relatives who returned surveys said that they were confident that if they made a complaint it would be taken seriously and acted upon. One relative said, “Staff are wonderful, always helpful and have time to listen.” The home has an excellent system of recording all complaints and ‘grumbles’, which shows that people are listened to and their issues are dealt with properly. The AQAA states that all staff are trained in safeguarding (abuse) procedures and referrals are made to the safeguarding team when necessary. The Commission for Social Care Inspection received a notification from the home in February 2008 about an incident involving two people living at the home. The situation in the home was dealt with properly but the safeguarding team were not notified. This issue was discussed with the manager at the time and she was reminded of her responsibilities. At this inspection care staff had a good
Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 17 understanding of the different types of abuse and knew how to report any safeguarding suspicions or allegations. Senior staff spoke about what to do if they had any safeguarding concerns out of normal office hours but it is recommended that this be reinforced and discussed at senior staff meetings. Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 18 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): Standards 19 and 26. People who use the service experience adequate quality outcomes in this area. The environment needs updated to make sure that it meets the needs of people living at the home. We have made this judgment using available evidence including a visit to this service. EVIDENCE: Some parts of the home need refurbishing. For example, some bathrooms had dark wall tiles making them look dingy and dated. Some bed bases were torn, some divan beds did not have a valance, which gave an institutional feel to the room, not all rooms had lockable space and although bedrooms and toilets had signs to help people with some degree of memory loss, there was poor signage from one corridor to another. The manager said that the 2008/9 budget was allowing an upgrade of all bedrooms, the purchase of height adjustable beds and coffee tables and footstools for lounges, upgrading of all main toilets and
Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 19 bathrooms, re-design of the main garden and patio and the replacement of some windows and carpets. The laundry facilities in the home are limited mainly due to the lack of space. This prevents separation of clean and dirty linen and could pose a cross infection risk. The manager is aware of this and is trying to access additional funding to address this issue. People living at the home were happy with their rooms. One person said, “I love it, I wouldn’t swap it for anything.” Similarly people were complimentary about the laundry service. One person said, “The laundry always comes back nicely ironed and it is always put back in your wardrobe on a hanger.” She went on to say that if she had any problems she only has to ask the ‘laundry lady’ and it is dealt with quickly. Good hygiene measures were seen during the inspection but during discussions with domestic staff it was clear that protective aprons and gloves are not worn when cleaning toilets and when coming into contact with body waste or spillages. One person said that she would only wear protective gloves if she knew someone had MRSA. This increases the risk of infection spreading in the home. Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 20 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): Standards 27, 28, 29 and 30. People who use the service experience adequate quality outcomes in this area. Staffing levels do not always meet the needs of people living at the home. This creates the risk of people living at the home being unsupervised or unattended. We have made this judgment using available evidence including a visit to this service. EVIDENCE: Information in the AQAA shows that there is a high level of sickness in the home both short and long-term. This has meant that some planned training has had to be cancelled. Rotas show that at times there are 4 care staff on a morning shift, 3 on an evening shift and 2 at night. There are 5 lounges, 2 on the second floor and 3 on the first floor. The AQAA shows that there are 17 people living at the home with dementia, 6 who have other mental health needs, 12 people who are incontinent and 4 who require the assistance of 2 staff during the day and night. Given the needs of the people living at the home and the layout of the building these staffing levels are not sufficient. Care officers spoke about the pressure that staffing levels cause and gave examples of having to do care and kitchen work in addition to their management duties. This means that management tasks are left to the end of their shift and are completed on a voluntary basis. This is unacceptable.
Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 21 Care officers also spoke about the difficulties with staff recruitment, such as the length of time the organisation takes to process recruitment documentation. They gave the example of a kitchen domestic who has not yet started work three months after her interview date. Staff shortages in the kitchen has meant that the main meal of the day, which was served at teatime, has had to be brought forward to lunchtime. This means some routines and practices are based around staffing levels rather than the needs and choices of people living at the home. Night staffing levels remain a cause of concern. Out of the thirteen falls that occurred in April 2008, 10 happened when night staff were on duty. This pattern was also identified at the last inspection. Information in the AQAA shows that 96 of staff have a National Vocational Qualification (NVQ). All new staff complete an induction programme that is based on the Skills for Care common induction standards and then move on to NVQ assessment. The training plan for 2008/9 shows that planned training includes safeguarding, the Mental Capacity Act, challenging behaviour, moving and handling, first aid, hoist training, lifestyle planning, death and dying, infection control, equality and diversity, dementia awareness, palliative care, pressure area care and catheter care. The manager said that community nursing staff deliver some training in the home, other training is delivered and/or arranged by the organisations training section and the remainder by distance learning workbooks through local colleges. The recruitment records of two people recently appointed were seen. Proper pre-employment checks had taken place. Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 22 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): Standards 31, 33, 35 and 38. People who use the service experience good quality outcomes in this area. There is good internal management of the home and staff try to act in the best interests of people living there. We have made this judgment using available evidence including a visit to this service. EVIDENCE: The registered manager provides clear leadership and stability to the home. She is very well organised and had developed monthly action plans to make sure that management tasks are identified, completed and reviewed. As a means of measuring the home’s performance against the aims and objectives the manager sends out regular satisfaction surveys to people living at the home, their relatives and health care professionals. The results of
Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 23 completed surveys are analysed and are then displayed throughout the home. Minutes of meetings, displayed on notice boards throughout the home, show that meetings take place with people living at the home and their relatives. These show that people are consulted and kept up to date with any changes happening in the home. One person living at the home said that she enjoyed these meetings. An informal newsletter is another way that the home tries to communicate with people and keep them informed. The AQAA shows that all financial transactions are followed using the organisation’s policies and procedures. Where money is held on behalf of people living at the home proper records are kept of all transactions. Those sampled were accurate and up to date. The home is subject to an external audit. Information in the AQAA shows that servicing and maintenance of equipment takes place as required. Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 24 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X 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 X 3 X 3 X X 3 Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 15 (1) (2) (a) (b) (c) (d) Requirement People living at the home must have a care plan that gives staff clear instructions on how to meet all aspects of the person’s needs. The care plan must be kept under review and wherever possible people must be involved and included in the review process. This will make sure that all aspects of people’s needs are met. This is outstanding from the inspection in April 2007. 2 OP26 13 (3) Domestic staff must wear protective clothing when cleaning toilets, spillages and coming into contact with bodily waste. This will prevent the spread of infection in the home. 3 OP27 18 (1) (a) There must be enough staff on duty at all times in all parts of
DS0000033228.V361581.R01.S.doc Timescale for action 31/07/08 30/06/08 31/08/08
Page 26 Harry Booth House Version 5.2 the home. This will make sure that people’s needs are met and that the safety of people living at the home and of staff is not compromised. 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 OP3 Good Practice Recommendations Information such as where the assessment took place, who was involved in the process and who provided the information should be recorded. This will make sure that the home’s pre-assessment has taken into account the views of all concerned and that it can meet people’s needs. 2 OP8 Risk assessments should show the specific risk to the individual. The action needed to reduce the risk should also be specific to the individual and the risk involved. This will make sure the action to reduce the level of risk is appropriate and relevant to each individual. 3 OP15 Where meals are blended, each item should be blended and served separately. The home should consider using moulds that represent the food that is being served. This will make sure that the meal looks appetising and that flavours, tastes and textures can be identified and distinguished. 4 OP18 How and when to report any safeguarding suspicions or allegations should be discussed at senior staff meetings. This will make sure that senior staff are familiar with
Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 27 safeguarding procedures and follow the correct guidelines. 5 OP26 The laundry facilities should be reviewed to make sure that there is separation of clean and dirty laundry. This is outstanding from the inspection in April 2007. Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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
© 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 Harry Booth House DS0000033228.V361581.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
