CARE HOMES FOR OLDER PEOPLE
Horsbere House Moorfield Road Brockworth Gloucester Glos GL3 4ET Lead Inspector
Mrs Ruth Wilcox Unannounced Inspection 20th February 2006 08:15 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 Horsbere House DS0000064618.V277353.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. Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Horsbere House Address Moorfield Road Brockworth Gloucester Glos GL3 4ET 01452 863783 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) The Orders of St John Care Trust Mrs Sitabeli Mlotshwa Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To accommodate 1 (one) named service user under 65 yrs old. This condition will be removed when the named service user reaches 65 years or leaves the home. 27th September 2005 Date of last inspection Brief Description of the Service: Horsbere House is a care home for forty-five older people, which provides personal and nursing care, and is also able to provide respite care. It is situated in Brockworth on the outskirts of Gloucester, is located close to local amenities, and is managed as part of The Orders of St John Care Trust. A Registered General Nurse is on duty twenty-four hours a day. All health care services are accessible from community resources, and residents can register with a GP of their choice, within the area. The accommodation was purpose built some years ago, and is provided on two floors. A staircase and shaft lift provides access to the first floor. Residents private accommodation is provided in single rooms on both floors. Hoisting equipment and assisted bathing and showering facilities are provided, and throughout the home there are grab rails and a resident call system. There are spacious and easily accessible toilet facilities conveniently situated. There are three lounges and a large, spacious dining room situated on the ground floor, and there is a small visitors lounge on the first floor. Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced inspection over 5.5 hours on one day in February. The inspector is very grateful to the home manager for all her kind cooperation and assistance with the inspection, given the demands already upon her on this day. The availability of information about the home to assist prospective residents and their families in making their choice about Horsbere House was looked at. Care records were inspected, and the care of four residents was closely looked at in particular; there was direct contact with eleven residents and four other staff. Their views regarding the standards of services and care at the home were sought wherever practicable. The arrangements for residents to make and pursue personal choices in respect of their daily lives were looked at, which also included their options for social activities. The system for ensuring the safekeeping of residents’ money and valuables was inspected. The provision of staff and the way in which they are recruited and supervised was inspected. A tour of the premises took place, with particular attention to the standard of maintenance and cleanliness in the environment. What the service does well:
A number of residents were spoken to during this visit, and generally they were very satisfied with the standards of care and attention they receive. Each seemed happy to confirm that in the main the staff are very helpful, kind and caring. Staff were observed at various times, and on each occasion were courteous and attentive, and were mindful of individuals’ choices and level of independence. There is a commitment towards ensuring that staff receive good supervision here, in order that work practices are monitored, and that they remain adequately equipped to carry out their role.
Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 Page 6 Each resident’s health and personal care needs are adequately met, with each having their own individually drafted plan of care, and access to all external health care services and professionals as required. The home has established a safe and transparent system to allow residents to place money or valuables in the main safe, keeping good clear records. What has improved since the last inspection? What they could do better:
The Orders of St John Care Trust have not yet produced updated and current versions of the home’s Statement of Purpose and Service User Guide. Work is reported to be ongoing at this time, and they are required to submit the new documents upon their completion to the CSCI. The standard of care planning continues to improve in many regards, but staff must ensure that they monitor and record weights of those residents who are nutritionally at risk for their own individual health reasons. Staff should also record fuller and more detailed reviews of individuals’ care plans, in order that current circumstances are more accurately reflected. There is a limited social activities programme here for residents, and there are plans to broaden this, with a more varied and regular programme, taking into account residents’ abilities and choices; this has yet to be fully developed and implemented however. The environment within Horsbere House, although adequately maintained and clean in most respects, is showing signs of wear and tear. Particular aspects of it appear tired and well used, however continue to provide safe and reasonably comfortable accommodation for the residents living there.
Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 Page 7 There are some specific waste collection bins that are not fit for their purpose at the time of this visit, and these must either be repaired or replaced, otherwise this will pose an infection control risk if left. Recruitment of staff is carried out in a methodical and thorough way in the vast majority of cases, however isolated instances of gaps in safe recruitment practice were identified during this inspection, which must be rectified so as to ensure safeguards for the residents. 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. Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 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 Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 The pre-admission information that is issued to prospective residents is not adequate to ensure they have access to sufficient information when making their choice about the home. EVIDENCE: Prospective residents are provided with an information brochure, which informs about the home and The Orders of St John Care Trust; the brochure does not contain all of the required information, and this is currently under review, with a revised and more up to date Service User Guide being produced by The Orders of St John Care Trust. The home’s Statement of Purpose is contained in a large folder, which is easily accessible in the main hall for anyone choosing to read it. This is also under review by The Orders of St John Care Trust; some of the information contained in here will actually need to be included in the new Service User Guide, to ensure that they fully meet the requirements. Horsbere House does not provide intermediate care.
Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 Page 10 Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 10. There is a consistent care planning system in place, which, in the main provides staff with the information they need to satisfactorily meet residents’ health and personal needs. Additional guidance and supervision for staff is provided to ensure that care and support is offered in such a way as to promote the privacy and dignity of the individual in a more consistent way. EVIDENCE: Each resident has a personal plan of care, which is directly linked to an individual assessment of their needs; three plans were chosen as part of a case tracking exercise. Care plans are generally well written, with clear instructions for staff to follow. Reviews of plans are carried out regularly, though some reviews contained little meaningful information. Records contained evidence of how residents’ health needs are met, through sourcing the appropriate health care services in the community and through good multidisciplinary working. Appropriate support equipment was observed
Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 Page 12 in use around the home, where assessed and required to meet certain needs. Interventions of other health care professionals are well documented. Appropriate risk assessments are documented, with recorded risk reducing actions for staff to follow. Care plans contained records of residents’ general condition and health, and weights were monitored and recorded. However, in two cases a weight did not appear to have been checked for some months, despite the assessments and care plans showing that the two were nutritionally at risk. There has been an increased focus on ensuring respect for residents, and on staff attitudes generally since the last inspection, following concerns raised at that time. A ‘Privacy and Dignity’ workshop was organised for staff, which was well received, with staff becoming more mindful of such issues. The manager and some of those staff spoken to indicate that it is a sensitive area that most are very mindful of, with supervision provided to others when needed. Care was being delivered to residents throughout the day in the privacy of their own rooms. When otherwise observed, staff were attentive to residents, and demonstrated friendly, but respectful attitudes to them. Documented plans of care clearly direct staff towards privacy and dignity issues, and also towards respect for whatever degree of independence is achievable for the resident. Residents themselves were happy with the care they received, with some saying ‘we’re looked after very well’, ‘staff are marvellous’, ‘we’re very lucky here, I like it very much’. One person said that some staff were better than others, but that generally staff were very good, and were mostly respectful. Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 14. A limited activities and entertainments programme is offered, with further ideas yet to be implemented, in order that residents can be provided with regular and varied opportunities for social activity. Respect is shown towards residents’ personal choices. EVIDENCE: Horsbere House has a designated activities coordinator, who when questioned, appeared to be only just developing the role. There is no planned social activity programme, and no records kept of any provided or of those participating, though there are regular social features such as bingo, hand and nail care, outings and monthly religious services. A small variety of games and musical entertainments have been provided, and special calendar dates and birthdays are always celebrated. There are plans to broaden opportunities and choice for people, which have yet to be developed, with regular access to different activities, such as crafts, jigsaw puzzles and board games, depending on individual preferences. A number of residents were observed sitting in the lounges, often quietly and unattended during the busy times, with the television on. Some were reading their newspapers, or doing their crossword puzzle.
Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 Page 14 Some were observed clearly choosing how and where they spent their time, and if able, were freely moving about the home according to their preference. One lady said that she preferred to remain in her room and listen to her radio, whilst another chose to remain alone and play a card game. One person said that she was free to do as she pleased, and that no-one had ever told her what to do, or that she couldn’t do anything. Residents’ bedrooms appear personalised, with many introducing treasured items of their own, and there is clearly choice available at mealtimes. Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 Page 15 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: The standards in this section were fully met at the last inspection, and none were assessed on this occasion. Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 Page 16 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 & 26. The standard of the environment generally provides residents with a clean, comfortable and safe place to live, although the age of it and some of its facilities is beginning to become more evident. EVIDENCE: Horsbere House was built some time ago, and although provides a comfortable and safe place for residents to live, is showing signs of age, wear and tear, in certain areas. Things such as the passenger lift and the built-in wardrobes look old and well used, certain old metal window frames are in poor states of repair, areas of paintwork are scuffed and damaged, and some curtains and bed linen, although serviceable, appear flimsy. A maintenance person is employed, and there is regular attention to cyclical and small maintenance issues. External contractors address larger maintenance issues appropriately. Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 Page 17 The home was clean and fresh, with no unpleasant odours anywhere. Gloves and aprons, liquid soap and paper towels are provided throughout the home. The home has a contract for the correct management of clinical waste; however, one of the collection bins did not have a lid, and the contents were exposed. Another household collection bin also did not have a lid, and the contents were spilling out onto the sluice floor. The laundry room provides appropriate facilities for the sluicing and disinfection of any foul or infected laundry; the laundry worker was conversant about the correct infection control procedures. There were reported to be plans to extend the laundry room. Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 29. Staffing provision is adequate to meet the needs of the residents currently living in the home. Robust recruitment procedures ensure that suitable staff are employed for the protection of residents, however any failure to observe these consistently could pose some risks. EVIDENCE: One registered nurse is on duty at all times, with eight care staff in the morning, and six in the afternoon and evening. Since the last inspection, recorded staff rotas now allow for an increase in care staff numbers overnight, with an extra carer on duty between the hours of 22.00 and 06.00, bringing this to one nurse and three carers. Also since the last inspection the deputy manager has left, and this position has yet to be re-appointed. The manager reported more successful recruitment of late, with agency usage reducing. For some time, Horsbere House has had to rely on agency or peripatetic cooks; this is now to be resolved with a more permanent arrangement, with cooks becoming contracted to the home. An ancillary team provides support to the care and nursing team, though the manager is currently awaiting a decision, based on financial planning, as to whether she can increase the amount of cleaning and laundry hours being
Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 Page 19 utilised; she feels that this will provide cleaning support throughout the day, thus ensuring greater consistency. There was a cohesive and efficient staff team on duty on this day, and residents’ needs seemed to be met in a timely way. Residents spoke positively about the staff team on the whole, indicating that they were helpful and kind. A selection of staff files was chosen for inspection, on the basis of their recruitment to the home since the last inspection of staff records. Each record contained application forms, including a full employment history in most cases; two work histories were incomplete. Interviews are recorded in writing. A photograph of one of the new workers had not been retained on file. Evidence of the required pre-employment checks was seen in all cases, although in two, despite evidence that CRB disclosures had been sought, there was no direct evidence that a CRB and POVA clearance had actually been received. It was reported that they had been received, but the manager agreed to report back to the inspector about it following this visit. Two workers had been recruited from overseas; all documentation received during the recruitment process is translated into English, although in one case, some of the documentation actually held in the home remained in the language of the country of origin. Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 Page 20 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): 35 & 36. There are good management systems in place to ensure that the financial interests of the residents are safeguarded. Staff receive regular guidance on how best to meet residents’ needs through a regular programme of supervision. EVIDENCE: Some residents have placed personal money and valuables with the home for safekeeping. Clear and transparent records for each person, which include transaction details, running totals, and receipts, are kept. Random audits on individual accounts proved to be accurate. Residents or their representative sign to acknowledge some transactions, but where this is not possible in the majority of cases, two staff members sign the record to witness on behalf of the resident. Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 Page 21 Since the last inspection, a number of senior staff have received supervision training, in order that they can assist the manager with the staff supervision programme. A new supervision matrix has been introduced, in order to monitor the programme, and ensure that each staff member receives at least the recommended number of individual sessions each year. Individual records of supervision are held in each person’s file. In addition to these structured sessions, staff also receive some degree of supervision whilst carrying out work practices. Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 3 X X Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 Page 23 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. 1 Standard OP1 Regulation 4(2) 5(2) Requirement The home must send the revised copies of the Statement of Purpose and Service User Guide to the CSCI upon completion. Staff must ensure that residents’ weights are monitored and recorded, particularly when assessed as being nutritionally at risk. The manager must make arrangements for all residents to engage in a programme of social activities to suit their varying abilities and needs. The manager must ensure suitable repairs or replacement of clinical and household waste bins where lids are missing, thus preventing the contents being exposed. When recruiting new workers, the manager must ensure that: • • A full employment history is obtained A photograph of the worker is retained. Timescale for action 31/05/06 2 OP8 12(1a) 31/03/06 3 OP12 16(2n) 31/03/06 4 OP26 13(3) 16(2j) 28/02/06 5 OP29 19(1) Sch 2 31/03/06 Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 Page 24 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 3 Refer to Standard OP7 OP12 OP29 Good Practice Recommendations Staff should record more detailed and meaningful reviews of care plans. The activities coordinator should devise a written plan of social activities, and keep records of those undertaken, and of those residents participating. The manager should ensure that all translated documents in cases of workers recruited from overseas, are held in the individual’s file in the home. Horsbere House DS0000064618.V277353.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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