CARE HOMES FOR OLDER PEOPLE
Hastings 130 Barnards Green Road Malvern Worcestershire WR14 3NA Lead Inspector
Y South Unannounced Inspection 17th November 2005 2.15pm 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 Hastings DS0000018685.V261916.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. Hastings DS0000018685.V261916.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Hastings Address 130 Barnards Green Road Malvern Worcestershire WR14 3NA 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) 01684 585000 Heart of England Housing and Care Limited Ms Johann Phelps Care Home 60 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (60), of places Physical disability over 65 years of age (60) Hastings DS0000018685.V261916.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th June 2005 Brief Description of the Service: This purpose built home is situated in a residential area of Malvern. There are local amenities a few hundred yards from the home and public transport to Malvern town centre. The home is purpose built on three floors and has shaft lift access throughout. There are 24 single bedrooms on each of the two upper floors and 12 single rooms on the ground floor. Each bedroom has en-suite facilities. Each floor has lounge and dining areas for the service users. There is also a level garden. The registered providers, Heart of England Housing and Care Ltd. state that they aim to provide a home for living in, where service users can expect to be treated as individuals and live life to the full. Mrs Phelps is the registered manager and the responsible individual for the company is Mr John McCarthy. Care is provided for a maximum of 60 service users over 65 years of age of either sex who may require care due to old age, a physical disability or a mental health problem. Hastings DS0000018685.V261916.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place over two and a half hours from 2.15pm until 4.45pm. The registered manager assisted the inspector. She also spoke to four residents, two visitors and one member of staff. A partial tour of the building and a range of documents were seen. The focus of the inspection was on the requirements and recommendations that had been made following the previous inspection, and standards concerned with the premises and health and safety. A service questionnaire was sent to the home prior to this inspection and returned to the Commission for Social Care Inspection. The manager was also asked to distribute other questionnaires regarding the service to residents, relatives and health care professionals. The completion of these is voluntary but proves useful in assessing the various views that are held. Sixteen responses were received. What the service does well:
This home provides a warm welcome to all who visit. The premises are attractively presented and well maintained and furnished. The facilities provided for the people who live in the home are of a high standard. The staff are courteous and helpful. Positives responses received in the questionnaires included: “Good communication exists between Hastings staff and myself. Staff are always willing to engage in joint working and liase well regarding any problems. The attitude within the home is very flexible and I think they try at all times to meet individual residents’ needs. Generally staff are very caring and I always feel welcome when visiting. The home has a good understanding of advocacy. Very pleased with recent placements. The home has been very responsive to care needs. Staff and in particular the manager are very receptive to discussing needs and problems of prospective and existing residents. I could not wish for anything better.” The service users said that they were very happy with their care they had no complaints and the staff were most kind and helpful. Two visitors endorsed this view. Hastings DS0000018685.V261916.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. Hastings DS0000018685.V261916.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 Hastings DS0000018685.V261916.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): EVIDENCE: These standards were not assessed during this inspection. Hastings DS0000018685.V261916.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): EVIDENCE: These standards were not assessed in full during this inspection. However compliance was checked with the seven requirements that had been made following the previous inspection. Five had been met. In the two records that were inspected it was observed that a full assessment and care plan was needed for pressure area care and behavioural issues. The provider is developing a new care recording system and the manager said that it would be piloted in the home in the near future. It is a less complex system which it is hoped will be more ‘user friendly’. Hastings DS0000018685.V261916.R01.S.doc Version 5.0 Page 10 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): EVIDENCE: These standards were not assessed during this inspection. Following the previous inspection it was recommended that the activities programme should be written in larger type. It was observed that the programme displayed on each floor was in large type and pictorially decorated. Hastings DS0000018685.V261916.R01.S.doc Version 5.0 Page 11 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): EVIDENCE: These standards were not assessed in full during this inspection. However the complaint record was inspected. Eight complaints had been received since the last inspection. Four of these had concerned the break down of the lift. This had been a serious and protracted problem in the home. Acceptable responses had been made by the provider and manager to address health and safety issues and expedite repairs but the quality of life had been compromised for those service users who lived on the upper floors. The providers had changed contracts to a more responsive lift engineering company who had since undertaken repairs with commendable speed. The purchase of a motorised evacuation chair was in progress. This would enable service users to be helped up and down stairs even if the lift was not operating. Two complaints had been raised by staff that were concerned about the changes to the night staffing routine. Intensive consultation had taken place to address their concerns without losing the benefits the changes would make to the care and safety of the service users. Discussion to resolve issues raised by the staff continue. The remaining two complaints concerned the standard of the laundry and a personality clash between service users. Both had been appropriately addressed.
Hastings DS0000018685.V261916.R01.S.doc Version 5.0 Page 12 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): 19 The service users have the facilities they need and live in a comfortable environment. However the appearance of the carpets in the communal rooms is unpleasant and the practice of storing large equipment in service users’ bathrooms makes use of these rooms difficult or impossible. EVIDENCE: A partial tour of the home was undertaken. The carpets in all communal areas were on a poor condition. Despite intensive cleaning they appeared soiled and unpleasant. This detracted from the otherwise pleasing appearance of the home. Everywhere else was clean and there were no unpleasant smells anywhere in the home. The newly decorated corridors had been enhanced by the display of pictures that had been donated of local scenes. Maintenance was of a high standard. Hastings DS0000018685.V261916.R01.S.doc Version 5.0 Page 13 The lack of storage space for large items of equipment was causing problems. For example in one bathroom there was a hoist, a carpet scrubber, 2 cleaners, 2 chairs, a bedside table and 2 cardboard boxes. In the day care room there was a mattress. Hastings DS0000018685.V261916.R01.S.doc Version 5.0 Page 14 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): EVIDENCE: These standards were not assessed during this inspection. However since the last inspection staffing had been rearranged to ensure specific staff were available to assist service users with their meals. This released other staff for care duties. A senior member of staff was available on each floor to ensure medication rounds were undertaken at the correct times. The vacant full time Hotel Services Manager post had been changed for two part time posts for a catering manager and a housekeeping supervisor. An appointment had been made to the catering post and recruitment was in progress to fill the other. Two service users made negative comments regarding food in the questionnaires. The manager said that now a catering manager was in post it was expected that the general standard would improve and the changes to the catering would be positive and stimulating. One service user was concerned about the staffing levels in the middle floor area where she lived. The manger was made aware of this. Hastings DS0000018685.V261916.R01.S.doc Version 5.0 Page 15 Concerns were expressed in some questionnaire responses that a senior member of staff was not always available and sometimes it took a long time for the phone to be answered. The manager said that a cordless phone was being purchased. This would ensure a speedy response to outside calls and location of senior staff. Also an administrative assistant was to be recruited which would also release senior staff from the reception area and administrative duties. Hastings DS0000018685.V261916.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): 38 The home operates with due regard for the health and safety of the people within. However staff need more frequent training to maintain their awareness of awareness of fire safety risks. EVIDENCE: A requirement was made following the last inspection that all staff should receive formal supervision at least six times a year. This requirement was not met and will therefore be repeated. No obvious hazards were observed in the home. The monitoring of health and safety matters was well recorded. Those for Legionella, water temperatures, wheelchair servicing, COSHH, PAT testing and fire safety were seen. Hastings DS0000018685.V261916.R01.S.doc Version 5.0 Page 17 Staff were receiving training in health and safety areas. However the frequency of fire safety training needed to be increased to meet the quarterly recommendations of the Hereford and Worcester Fire Authority. Hastings DS0000018685.V261916.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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 X X X X X X X STAFFING Standard No Score 27 3 28 X 29 X 30 X X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 2 X 2 Hastings DS0000018685.V261916.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 OP8 Regulation 13(4) Requirement Risk assessments for skin care needs must be completed in detail and supported by appropriate care plans. Risk assessments for any aspects of challenging behaviours must be completed and supported by appropriate care plans. Carpets in communal areas must be replaced. Large items of equipment must not be stored in service users’ communal and private rooms. All care staff must receive formal supervision at least six times each year. All staff must receive fire safety training in accordance with the recommendations of the Fire Authority. Timescale for action 31/12/05 2. OP8 13(4) 31/12/05 3 4 5. 6 OP19 OP19 OP36 OP38 23 23 18 23 01/06/06 01/06/06 31/12/05 31/12/05 Hastings DS0000018685.V261916.R01.S.doc Version 5.0 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hastings DS0000018685.V261916.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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