Inspection on 16/08/05 for Howards

This inspection was carried out on 16th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Howards 24/09/08

Howards 27/09/07

Howards 05/03/07

Howards 08/12/05

Howards 20/12/04

Howards 13/08/04

Similar services:

Old Hastings House

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Howards 24 Rowtown Addlestone Surrey KT15 1EY Lead Inspector Mary Williamson Announced 16/08/05 10:30 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 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. Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Howards Address 24 Rowtown, Addlestone, Surrey, KT15 1EY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01932 856665 Greydales Ltd Julia Ghassemi CRH 21 Category(ies) of OP - Old Age - 21 registration, with number SI - Sensory Impairment - 1 of places Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The age/age range of the persons to be accommodated will be: Over 65 years of age. One (1) named service user of age 59 years may be accommodated. Date of last inspection 20/12/04 Brief Description of the Service: Howards is a care home situated in a quiet residential area on the outskirts of Addlestone. It provides care for twenty-one service users who are old. Accommodation is arranged on two floors, with nineteen single bedrooms and one double bedroom. There are two lounges and a conservatory which, is also the dining room. This overlooks a well maintained garden with two fish ponds and ample garden furniture. There is a shaft lift to access the first floor. There is off the road parking at the front of the premises. The home hires a mini bus from a local charity to provide outings for service users. Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and the first in The Commission for Social Care Inspection programme year 2006/2006. Mary Williamson the lead inspector for the service undertook the inspection over a period of five hours. The registered manager was on leave and Clare Samuel a senior carer was in charge and present throughout the inspection. Mr G. Samuel the provider was also present. All the service users were spoken to during the inspection and four service user comment cards were received. No relatives were available during this visit. A tour of the premises was undertaken and records relating to the care of the service users and the management of the home were examined. A discussion took place with four service users and various comments received which have bee reflected in the report. Staff were interacting with service users in a positive and kind manner. Service users are well cared for and were undertaking various activities, from catalogue shopping to reading their individual newspapers. Sherry was offered to service users in the large lounge prior to lunch, which was appetising and wholesome. The inspector would like to thank the service users, staff, and management team for their positive and helpful approach to the inspection process. What the service does well: Howards provides good care and support to service users in a comfortable and homely environment. The standard of care planning is good with service users involved in this process. The individual and communal accommodation is satisfactory with the garden being an attractive feature and enjoyed by all the service users. Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 Page 6 There is a well- established team of staff in post who relate well to the service users, and have a good understanding of their needs What has improved since the last inspection? What they could do better: The home continues to provide good care in a homely environment. The medication policy needs to be revised to include a risk assessment for selfadministration of insulin. Fire safety training for staff must be updated regularly and records kept on personal files. The Commission for Social Care Inspection needs to be informed in accordance with Regulation 37 of the Care Homes Regulations of any incident or event affecting the service users wellbeing, for example when a service user is admitted to hospital. Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 Page 7 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. Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 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 standard(s) 1, 2, and 3. Prospective service users have access to the information required to enable them to make an informed choice about living at Howards. Contracts and assessments demonstrate that the wellbeing of service users is safeguarded. EVIDENCE: There is a statement of purpose and service users guide in place. All prospective service users and their designated representative have access to a copy of this prior to admission to the home. Individual contracts of occupancy were seen. These include fees to be paid and additional charges if applicable. The service user or relative signs two copies. One is retained on file and the other given to the service user. The manager undertakes a full pre-admission needs assessment or nominates a member of staff qualified to do so. Prospective service users are usually invited to spend a day in the home during which time the assessment will be undertaken. The home has an assessment tool in place for this purpose. Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 Page 10 Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 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 standard(s) 7, 8, 9, and 10 Appropriate arrangements are in place to ensure that service users health care needs are met and outlined in well -documented care plans. Shortfalls identified in the medication procedures do not safeguard the selfadministration of medication. EVIDENCE: Individual care plans are in place for all service users. These have been improved since the last inspection and now also computerised. The care plans sampled are detailed and informative. Service users and their relatives are included in the care planning process. All service users are registered with a local GP and are seen on a regular basis. The district nurses also visit the home frequently to undertake dressings, blood tests, and injections. There is access to chiropody treatment and dental treatment. A visiting optician also visits the home. There is currently input from the continence advisor. There is a policy in place for the administration of medication. The blister pack system is in use. Staff who are responsible for the administration of medication receive regular training updates. The medication recording charts Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 Page 12 are well maintained; one of these charts requires photographic identification. The list of staff signatures is out of date and requires to be updated. A risk assessment needs to be in place for the self- administration of insulin. Privacy and dignity is respected and staff were observed to knock on service users bedroom doors prior to entering. Service users can see relatives, friends, and visiting professionals in the privacy of their own room. Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 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 standard(s) 12, 13, and 15. The lifestyle experienced in the home generally meets the expectations of the majority of service users. Community and family links are supported. The catering arrangements are adequate to meet the service users needs. EVIDENCE: Activities are arranged collectively and individually. A group discussion took place with four service users and generally they seemed satisfied with the entertainment and parties provided. They did feel however that more outings could be arranged. On the morning of the inspection some service users were shopping from a catalogue, and others were reading their daily newspaper. Sherry was offered in the lounge prior to lunch. Community links are maintained and some service users attend the local Cameo Leisure Club. Spiritual needs are supported and the local clergy visit on a regular basis. Relatives and friends are encouraged to visit at any reasonable time. Some service users stated that family and friends take them out and are invited to home functions. Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 Page 14 The menus were seen and offer a wide range of wholesome, appetising, and nutritious food. Several service users stated that the food was good. The lunch on the day of the inspection was roast chicken, roast potatoes, and a selection of vegetables, followed by home- made cheese cake. There is anew cook in post and she stated that she is undertaking her food hygiene training in September 2005. The kitchen is clean and orderly. The fridge and freezer temperatures were not been monitored regularly and need to be tested and recorded at least once a day. Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 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 standard(s) 16 and 18 Service users are protected by the complaints and abuse procedures in place. EVIDENCE: There is a complaints procedure in place and all service users and their relatives have access to a copy of this. It is also included in the service users guide. There have been no complaints since the last inspection. The home has a policy on abuse awareness in place and all staff have training in this during their induction training. The home also has a copy of Surreys Multi Agency’s Protection of Vulnerable Adults procedures in place. Training is ongoing in these procedures and recorded in staff files. Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 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 standard(s) 19, 20, 21,24, and 26. The service users live in a clean, and well- maintained environment. Both individual and communal space meets the service users needs. EVIDENCE: The home is accessible and well maintained. It provided a comfortable and homely environment for service users to live in. There are two lounge areas and a dining area, which is also the conservatory. This overlooks a well maintained garden, which has two fishponds, and garden furniture. Individual bedrooms are comfortably furnished and personalised to reflect service users personalities. Some bedrooms have been re-carpeted since the last inspection. There is a parker bath and a shower room located on the ground floor. The carer in charge stated that all the service users use both of these facilities as mobility needs prevents them from utilising the bathroom on the first floor. Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 Page 17 During a group discussion with four service users they stated that this arrangement was satisfactory. The home is clean and tidy and free from offensive odour with the exception of one bedroom. The carer in charge stated that this situation is being monitored daily and the continence advisor is also involved. Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, and 28. The duty rota indicated the number and skill mix of staff on duty was adequate to meet the assessed needs of the current service users. Fire safety training needs to be updated for some staff. EVIDENCE: There was sufficient staff on duty during the inspection to meet the assessed needs of the current service uses in the home. Several service users were very complimentary about the staff and the care they provide. In addition to the care team the home also employs a cook, a cleaner and a laundry assistant all of whom have clear defined job descriptions. Staff training records were examined and indicated that a wide range of training has been provided internally and externally. However records show that the fire safety training for the night staff is considerably out of date and needs to be updated. Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 37, and 38 The home is well run. The home is not reporting illness or any other events to the inspector. The health and welfare of the service users is promoted and protected with the exception of the fire training for the night staff. EVIDENCE: The home manager was on annual leave on the day of the inspection and Clare Samuel a senior carer was in charge. The home was functioning well and all the staff were well organised and all were aware of their duties and responsibilities. The staff and service users stated that if they had a problem regarding any aspect of the home then they would have the confidence to discuss this with the manager. One of the service users was in hospital. The manager must inform The Commission for Social Care Inspection of such events under Regulation 37 notifications. Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 Page 20 Health and safety policies and procedures are in place and these were sampled during the inspection. Staff training is ongoing around these procedures. The accident records were seen and the procedure for recording these is satisfactory. The fire safety records are well maintained and contracts are in place for the maintenance of fire fighting equipment. However shortfalls were noted in the frequency of fire safety training for night staff. Training must be arranged immediately. The manager must ensure that the cook attends her food hygiene training and successfully completes this. She must also ensure that the fridge and freezer temperatures are recorded daily. Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 x x 3 x 2 STAFFING Standard No Score 27 3 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x x 2 2 Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 Page 22 NO 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. 1. Standard 9 Regulation 13(2) Timescale for action The registered person shall make 30/09/05 arrangements for the safe administration of medication in the home. The registered person shall 30/09/05 ensure that a risk assessment is in place for self administration of medication. The registered person shall 30/09/05 ensure that the home is kept free from offensive odour. The registered person shall make 30/09/05 arrangements for staff to receive suitable training in fire prevention, and arrange fire drills at suitable intervals. The registered person shall give 30/09/05 notice to The Commission for Social Care Inspection of an event which adversely affects the well being or safety of service users to include admissiond to hospital. The registered person shall also make sure that daily records are kept of fridge and freezer temperatures. Requirement 2. 9 13(4)(b) 3. 4. 26 28 and 38 16(2)(k) 23(4)(d) and (e) 5. 15 and37 37(1)(e) Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 Page 23 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 21 Good Practice Recommendations Consideration should be given to the instillation of an assisted bath or shower on the first floor for the convenience of the service users living on the first floor. Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 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 Howards h09-h58 s13683 Howards v235243 160805 stage 4.doc Version 1.40 Page 25 - 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. 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