CARE HOMES FOR OLDER PEOPLE
High Lea House Llanforda Rise Oswestry Shropshire SY11 1SY Lead Inspector
Pat Scott KEY Unannounced Inspection 27th June 2007 11:00 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 High Lea House DS0000020713.V344123.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. High Lea House DS0000020713.V344123.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service High Lea House Address Llanforda Rise Oswestry Shropshire SY11 1SY 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) 01691 654090 NONE yvonnej.wakefield@virgin.net Miss Yvonne Wakefield Miss Wakefield Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places High Lea House DS0000020713.V344123.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st May 2006 Brief Description of the Service: High Lea House is a privately owned residential home providing personal care for up to twenty-nine older people. The registered proprietor and manager is Miss Yvonne Wakefield who has managed the home since 1984. Miss Wakefield and her partner Mr Edwards own the cottage opposite the home and provide on call support as well as having active roles in the running of the home. High Lea House is an impressive house, which has been converted and extended. It is set in its own grounds in a quiet residential area but within easy reach of the centre of Oswestry. The home benefits from its raised position, with a number of rooms having extensive views across Shropshire and the pleasant gardens of the home. The home provides single and double accommodation some rooms having en-suite facilities. There is a large lounge, a pleasant conservatory, a dining room and a quiet room offering service users choice as to where they wish to spend their time. The first floor is accessed by a shaft lift and all areas of the accommodation are accessible. Visitors to the home are frequent, good links with the local community are maintained by the home. The home makes their services known to prospective service users in The Statement of Purpose. The inspection report is mentioned in this document and is given out on request. Fees are reviewed annually and range from £324 - 360. The only additional charges to service users are for toiletries, hairdressing and newspapers. This is clearly laid out in the terms and conditions. High Lea House DS0000020713.V344123.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider in the annual quality assurance assessment, staff records kept in the home, medication records, discussion with people who use the service and surveys, discussions with the staff team, discussion with the owner, tour of the premises, previous inspection reports, quality assurance processes, Fire Authority reports, Environmental Health Office reports, observation of care experienced by people using the service. What the service does well: What has improved since the last inspection?
The owner has installed a commercial air conditioning system in the two conservatories, as in warm weather service users found them too hot. The owner has ensured that the physical environment of the home provides for the individual requirements of the people who live there. The living environment is appropriate for the particular lifestyle and needs of the residents and is homely, clean, safe and comfortable and well maintained. When lounge chairs were replaced, service users had a choice of chair and some wished to keep their existing chairs, which was respected. The owner
High Lea House DS0000020713.V344123.R01.S.doc Version 5.2 Page 6 also intends to re decorate the lounge as the service users wanted something to “go with the new furniture”. Changes to the menu have occurred through listening to service user comments. The mealtimes did not change, again due to service user request. There are plans to build a 120 metre walkway, so service users have more space to walk within the grounds. The content of the care plans and social history element has improved. More detail is recorded and provides a dignified insight into the individual’s life before entering long term care. 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. The summary of this inspection report can be made available in other formats on request. High Lea House DS0000020713.V344123.R01.S.doc Version 5.2 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 High Lea House DS0000020713.V344123.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. Key Standards 3 National Minimum Standards 4,5 This judgement has been made using available evidence including a visit to this service. The home’s ethos and records demonstrate that the admission process is informative, personalised and that consideration has been given to all aspects of care. EVIDENCE: Prospective service users are offered the opportunity to visit the home and have discussions with staff and service users. They can spend several hours, an afternoon or a day at the home before deciding whether to come in for a trial period. Trial periods are flexible to meet the preferences of the service user which allows them to keep control of their admission process. The owner will also visit the service user at their own home or in hospital to gain information required about their needs. Records are kept about all contact prior to the person coming to live at High Lea House. These show that
High Lea House DS0000020713.V344123.R01.S.doc Version 5.2 Page 9 assessment is a continual process so that the service can decide whether or not it can meet their needs. Four service user assessments were seen. The assessments were personalised and addressed physical health, mental health, social care and spiritual needs of the individual. The owner keeps copies of the assessment summary and care plans of those carried out through care management arrangements. A service user spoken with stated that he had provided information about himself to the manager prior to coming to live at the home. High Lea House DS0000020713.V344123.R01.S.doc Version 5.2 Page 10 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): Quality in this outcome area is excellent. Key Standards 7,8,9,10 This judgement has been made using available evidence including a visit to this service. Service users’ care needs and risk assessments are set out in their individual plans of care which ensures that all care needs have been addressed and will be fully met. The manager understands the need to comply with safe medication systems and staff practice ensures that the home’s procedures are complied with and that service users health matters are always safely addressed. The actions of staff and their approach to care ensures that service users are treated with respect and their right to privacy is upheld. EVIDENCE: Four care plans were examined. All had care plans derived from the initial assessments and were signed by the individual service user. Each plan had a recorded monthly evaluation of the elements of care. They provide detail in
High Lea House DS0000020713.V344123.R01.S.doc Version 5.2 Page 11 how care is to be delivered by staff and of individuals preferences. Daily records monitor the progress of individuals. The plans demonstrate contact with healthcare professionals such as district nurse or GP. Service users spoken with stated that support is flexible as they spoke of the various bed/rising times which are accommodated and always delivered in a way that respects their privacy. One person commented, ‘I am very satisfied with the service, it is my home’. Personal histories are very detailed in the ‘My life before you knew me’ record. All service users complete a food questionnaire and are given choices about the food they eat. Service users are weighed monthly and appropriate action taken if significant variations are noted. Service users all appeared well groomed with their hair, nails and clothes looking clean. No issues were identified in discussions regarding approach of staff or being assisted with intimate tasks. The service accepts responsibility for administering medication to service users via the monitored dosage system. The service has safe storage facilities but at present does not have the correct storage for controlled drugs (CD) in the medication room. The owner agreed to review this. Written records for receipt had one signature at the top of the medication administration chart and items ‘ticked’ as received. High Lea House DS0000020713.V344123.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is excellent. Key Standards 12,13,14,15 This judgement has been made using available evidence including a visit to this service. Service users are provided with social activity and can keep in contact with family and friends. Social, cultural and recreational activities meet service user’s expectations through assessment, consultation and choice. Residents receive a healthy diet according to their assessed requirement and preference. EVIDENCE: The assessment process demonstrates that social/leisure pursuits are addressed prior to admission in a personalised way for the individual. Once living at the home, social activities are provided and the service shows that this is based on service user consultation through regular service user meetings regarding all aspects of living at High Lea House. Many photographs were on display of events. Newspapers, magazines and books were seen around the home with some people reading quietly or walking in the grounds. Service users are supported to organise their own group activities, e.g. one service user organises activities with other service users while another organises regular games of bridge, inviting her friends, who are
High Lea House DS0000020713.V344123.R01.S.doc Version 5.2 Page 13 not service users, to her room. A fridge and tea making facilities are provided by the home. Surveys confirmed that visitors are not restricted and the home has an ‘open door’ so that service users can come and go as they please. Service user consultation identified the desire to have more access to the large grounds. The owner has plans to provide a walkway to address this request. All service users spoken with said they liked the food and it is always nicely cooked and have been impressed with the new Chef. Service users were seen having their lunch in an attractive dining room. High Lea House DS0000020713.V344123.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is good. Key Standards 16,18 This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure which is accessible so that people who use the service have information of how to make complaints about the home. Training is provided so that service users are protected from abuse and have their legal rights protected. EVIDENCE: Service users surveys stated they know whom to approach if they have a problem. All expressed confidence that issues would be dealt with. There is a high level of accessibility to the management at this home which ensures that concerns can be dealt with very quickly. Previous inspections have identified that staff receive full training on safeguarding adults. High Lea House DS0000020713.V344123.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. Key Standards 19,26 This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home has improved, through service user choice, so that they live in a safe, better-maintained and comfortable environment, which encourages independence. EVIDENCE: All areas seen around the home are clean and rooms personalised and decorated according to the wishes of those service users occupying them. The owner has provided new carpet and furniture in many bedrooms and in the conservatory. Air conditioning in the conservatories has made it more pleasant for service users to use. The choice and style of furnishings respects the diversity of service user groups regarding preference; for example not all elderly service users wanted ‘older style’ wallpaper in the lounge and wanted a
High Lea House DS0000020713.V344123.R01.S.doc Version 5.2 Page 16 fresh modern feel to their communal space. The service has respected this viewpoint. The laundry room is small but functional to meet the needs of service users accommodated. The wall tiles and flooring have been renewed. High Lea House DS0000020713.V344123.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is excellent. Key Standards 27,28,29,30 This judgement has been made using available evidence including a visit to this service. Staff in the home are being trained and are in sufficient numbers to fill the aims of the home and meet the changing needs of service users. EVIDENCE: NVQ training is provided and the minimum ratio of 50 trained staff being at level 2 has been exceeded with almost 100 having the qualification. 75 have completed level 3. Other recent training provided includes; infection control, medication and adult protection as well as the statutory updates. The management input is supernumerary to care staff numbers. Staff turnover in the home is low so that continuity of care is provided. The service users know the staff very well and observation showed that they provide a personal but professional service. Service users commented that staff are ‘very kind’, ‘excellent’. The service demonstrates a thorough recruitment process with good records kept. Staff files have a record of training dates attended. High Lea House DS0000020713.V344123.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is excellent. Key Standards 31,33,35,38 This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect and with effective quality assurance systems and audits in place, service users are assured that the overall conduct of the home is being well managed. EVIDENCE: The owner is competent to run the service and demonstrates a desire to continually improve the service to provide value for money. She is aware of the running costs of the home which she has effectively used to provide better outcomes for service users, e.g. the injection of cash to fund the redecoration and improvements of the premises. The owner’s practice is very service user
High Lea House DS0000020713.V344123.R01.S.doc Version 5.2 Page 19 focussed and customer satisfaction is high on the agenda. This is evidenced by the commitment to conducting service user meetings and surveys. People who use the service stated that they trust the staff and feel safe in the home. Good record keeping systems are in place. All records seen are written in a way that shows the service listens to the people who use it. What people say is heard, acted upon and reviewed and elements of the annual quality self assessment were seen to be in place. E.g. air conditioning, particular activities, improved care plans. High Lea House DS0000020713.V344123.R01.S.doc Version 5.2 Page 20 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 4 4 4 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 3 High Lea House DS0000020713.V344123.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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. 1 2 Refer to Standard OP9 OP9 Good Practice Recommendations The storage of medication could be improved by having a CD box in place which complies with legislation. The manager should record the receipt of all medication more accurately. High Lea House DS0000020713.V344123.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate Shrewsbury SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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