CARE HOMES FOR OLDER PEOPLE
Heversham House Heversham Milnthorpe Cumbria LA7 7ER Lead Inspector
Mrs Margaret Drury Unannounced Inspection 15th February 2006 11:15 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 Heversham House DS0000022651.V281016.R01.S.doc Version 5.1 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. Heversham House DS0000022651.V281016.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Heversham House Address Heversham Milnthorpe Cumbria LA7 7ER 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) 015395 63769 Mrs Isobel Hellena Wales Mrs Isobel Hellena Wales Care Home 13 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (12) of places Heversham House DS0000022651.V281016.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Old Age not falling within any other category (12). To include one named service user in the category of Dementia over 65 years of age (1) 27th July 2005 Date of last inspection Brief Description of the Service: Heversham House is a care home registered to accommodate 13 older people. It is situated in a small village close to Milnthorpe, a market town on the edge of the Lake District. The premises comprise a detached Georgian residence with a very attractive walled garden. There is a small car park at the rear of the home. The house has many original features including attractive bay windows, delft tiled fireplaces and corniced ceilings. There is a large lounge / dining room and a small quiet sitting room on the first floor where residents can meet visitors in private. The gardens are pleasant and private. The home is owned and managed by Mrs Wales, with her daughter working as the deputy manager. Heversham House DS0000022651.V281016.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the home and took place over late morning and early afternoon. This was the second inspection of the annual cycle and those standards not assessed on this occasion were inspected and met on the previous visit that took place in July 2005. During the inspection time was spent with the manager and deputy and speaking with residents in their rooms or in the lounge. The inspector was also able to speak with family members who were visiting at the time of the inspection. Documentation concerning the running of the home and care of the residents was examined and some parts of the home were looked at. What the service does well: What has improved since the last inspection?
External decoration has been completed and one of the large bay windows at the front of the house has recently been replaced. Arrangements have been made for a professional company to come and check all the water temperatures every month. Records were available for examination by the inspector.
Heversham House DS0000022651.V281016.R01.S.doc Version 5.1 Page 6 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. Heversham House DS0000022651.V281016.R01.S.doc Version 5.1 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 Heversham House DS0000022651.V281016.R01.S.doc Version 5.1 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 The home’s statement of purpose and resident guide are good, providing prospective residents and their families with details of the services the home provides. This enables an informed decision can be made about admission to the home. EVIDENCE: The home has a detailed statement of purpose and resident guide in place, both of which provide all the necessary information for prospective residents and their families to make an informed choice about moving into the home. Discussions with family members during the inspection evidenced that they were given copies of both documents when they first visited to look around and view any vacant rooms. Heversham House DS0000022651.V281016.R01.S.doc Version 5.1 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): 9 & 11 The healthcare needs of the residents are understood and well met. Medication and records are well maintained to ensure the protection of the residents. The residents benefit from knowing all their wishes will be met with dignity and sensitivity. EVIDENCE: The pharmacist provides the medication in a monitored dosage system with those staff responsible for its administration having completed the appropriate training. The records were checked and found to be correctly and neatly completed. The pharmacist providing the medication completes an annual audit of the records, medicines and tablets and the deputy manager said the pharmacy staff are always available for help and advice. The pharmacist from Morcambe Bay Trust also comes on an annual basis to complete a medication review for all the residents. Both these two audits ensure the safety and well being of the residents. The residents who spoke with the inspector said they “only had to ask” and the doctor would visit at the request of the home.
Heversham House DS0000022651.V281016.R01.S.doc Version 5.1 Page 10 Discussions with the deputy manager confirmed that every effort is made to ensure all the wishes of the resident are met with care and sensitivity. Heversham House DS0000022651.V281016.R01.S.doc Version 5.1 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): 14 Service users benefit from being able to express their wishes about how to spend their time and are given the choice about whether or not to join in any organised activities. EVIDENCE: The residents who spoke with the inspector both before and after lunch expressed their pleasure at being able to stay in their rooms or sit in the lounge/diner whichever that wanted. One resident had just returned from an overnight stay with her daughter. Although there are limited activities the inspector was able to watch the armchair exercises taking place in the lounge after lunch. None of the residents want to attend structured meetings and the staff are able to discuss any relevant matters with them on a one to one basis over a cup of tea. Heversham House DS0000022651.V281016.R01.S.doc Version 5.1 Page 12 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): All of these standards were assessed and met during the last inspection. EVIDENCE: Heversham House DS0000022651.V281016.R01.S.doc Version 5.1 Page 13 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): 21 & 22 The home offers comfortable and homely accommodation and all areas are well maintained. This, together with the provision of specialist equipment, contributes to a good quality of life that maximises independence. EVIDENCE: Three of the bedrooms provide en-suite toilet facilities and there are communal toilet and bathing facilities on each floor. The home provides specialist equipment such as hoists, assisted bathing and raised toilet seats in order that the residents may retain as much independence as possible for as long as possible. There is a stair lift and handrails on the corridors to assist with movement around the home. Heversham House DS0000022651.V281016.R01.S.doc Version 5.1 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): All of these standards were assessed and met during the previous inspection. EVIDENCE: Heversham House DS0000022651.V281016.R01.S.doc Version 5.1 Page 15 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): 34 36 Residents benefit from health and safety policies and procedures that are put in place to protect their welfare. Liaison between the registered provider and professional accountants ensure the viability of the home. EVIDENCE: The registered provider works closely with her accountants to ensure the viability of the home. There are health and safety policies in place and a number of the staff are recognised fire wardens. Risk assessments covering first aid, fire safety, control of hazardous substances have all been completed and an external professional company checks water temperatures each month. The deputy manager, who is also responsible for the premises risk assessments, carries out regular checks of the building and ensures any work that is required is completed.
Heversham House DS0000022651.V281016.R01.S.doc Version 5.1 Page 16 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X 3 3 X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X 3 X X X 3 Heversham House DS0000022651.V281016.R01.S.doc Version 5.1 Page 17 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 Heversham House DS0000022651.V281016.R01.S.doc Version 5.1 Page 18 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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