CARE HOMES FOR OLDER PEOPLE
Howbury House Pickersleigh Grove Malvern Worcs WR14 2LU Lead Inspector
Y South Unannounced Inspection 13th October 2005 09:00 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 Howbury House DS0000037483.V252121.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Howbury House DS0000037483.V252121.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Howbury House Address Pickersleigh Grove Malvern Worcs WR14 2LU Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01684 571750 01684 571753 Worcestershire County Council Ms Patricia Averil Ball Care Home 36 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (36), of places Physical disability over 65 years of age (36) Howbury House DS0000037483.V252121.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The home may also provide this intermediate care to service users over the age of 60 who have a physical disability. The home may provide intermediate care for a maximum of 16 service users whose needs are in categories OP and PD/E. The home may accommodate one person under the age of 60 years for intermediate care.. 18/04/05 Date of last inspection Brief Description of the Service: Howbury House is located a short distance from the main road that runs through Malvern Link. There is easy access to public transport and shops. The home is a large single storey building arranged in units and provides single bedrooms for a maximum of thirty-six older people. Each unit has its own communal toilets and lounge/dining area, and each pair of units shares a kitchen and bathroom. The house is surrounded by an attractive garden with views of the countryside and the Malvern Hills. Intermediate care can be provided for seventeen people comprised of eleven places for rehabilitation and six places for assessment of older people with physical and/or mental health needs. Respite care is also provided. There are currently only two permanent service users resident in the home as this service is being phased out and people are no longer admitted to live in the home permanently. A Day Care Unit, operating five days each week, provides a service for between 10 and 12 people. The unit is staffed separately from the home and is not inspected as part of the care home. The home is owned by Worcestershire County Council and managed by Mrs Ball. Howbury House DS0000037483.V252121.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place over three and a half hours between 9am and 12.30pm. Mrs Ball and Ms Stokoe gave assistance. The inspector also spoke to three service users and four staff, and looked at a range of records. The inspection focused on the requirements arising out of the previous inspection, and the standards relating to staffing and management. A service questionnaire was completed by the home and returned to the Commission for Social Care Inspection. The manager was asked to distribute other questionnaires regarding the service to service users, relatives and health care professionals. The completion of these is voluntary but proves useful in assessing the various views that are held. Eleven responses were received. What the service does well:
The opinions of people who use this home are valued. The questionnaires that have been returned to the Commission for Social Care Inspection are very positive and include comments such as ‘excellent home, excellent communication, well run home, caring staff, excellent service, immediate decisions, very pleased with the care, always made welcome, nothing is too much trouble, plenty of freshly cooked food, a lovely home, cannot speak too highly of the home, staff are always cheerful and helpful, feels like a real home, food is excellent, impossible to fault, excellent care, treated with kindness, service is wonderful, food was really good, I was really happy there, it would be good if I could live there’. The house is well maintained, clean and comfortable. The decoration and furnishing are attractive and suitable for the purpose. Staff have good access to training and this is encouraged and supported by the managers. Howbury House DS0000037483.V252121.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Howbury House DS0000037483.V252121.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Howbury House DS0000037483.V252121.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed during this inspection. EVIDENCE: A requirement arose out of the previous inspection that prospective service users must have a full and up to date assessment of their needs prior to any admission to the home. The current pre-admission assessment undertaken in the Community Care Assessment lacked the detailed information necessary in order to compile an effective care plan. It was acknowledged that the home would be able to undertake a more thorough assessment. Therefore it was recommended during this inspection that, as part of the admission process, full nutrition, pressure care and moving and handling assessments are completed in the home on which to base appropriate care plans. Howbury House DS0000037483.V252121.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed during this inspection. EVIDENCE: Service users told the inspector that they were very pleased with the care they were receiving. They thought staff were very pleasant and persuasive and helpful. Howbury House DS0000037483.V252121.R01.S.doc Version 5.0 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed during this inspection. EVIDENCE: Good interaction was observed between staff and Service users. People were reading newspapers and magazines, watching the television, sleeping and playing dominoes with the staff. Howbury House DS0000037483.V252121.R01.S.doc Version 5.0 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Theses standards were not assessed during this inspection. EVIDENCE: A requirement was made in the previous report to update the complaint procedure. This had now been done. The service users confirmed that they knew how to raise their concerns and would have no problem doing so. However one person said that it was not likely to be an issue as in her opinion the home could not be faulted. Howbury House DS0000037483.V252121.R01.S.doc Version 5.0 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 The service users live in an environment that suits their needs. Building work to improve facilities is being undertaken with due regard for their welfare. Facilities and equipment, supported by staff training, ensures that the risks of cross infection are kept as low as possible. EVIDENCE: The inspector toured the building. Everywhere was seen to be clean and well maintained. It was a credit to the staff. The manager said that the new storage facilities were almost ready for use and money had been identified to build a smoking room and the sunroom next year. Good progress was being made in the building of the new assessment room.
Howbury House DS0000037483.V252121.R01.S.doc Version 5.0 Page 13 Some bedrooms had been redecorated and furnished. There were new curtains and carpets in some areas and new equipment had been purchased. Laundry facilities had been improved and the laundress said that she was very happy with what had been provided. A service user commented that she had been agreeably surprised to have her washing done for her and to a high standard. Measures were in place to reduce the risks and control the spread of infection. Howbury House DS0000037483.V252121.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30. Sufficient skilled staff are employed to meet the needs of the service users. The recruitment procedure ensures that suitable people are employed to safely provide care for the service users. A strong commitment to training ensures staff have the knowledge and skills to undertake their duties. EVIDENCE: A copy of the current duty roster indicated that the home was acceptably staffed and vacant shifts had been covered. The manager said that they had needed to use more agency staff of late, as there were five posts vacant. None the less the needs of the service users were being met and the home had an excellent working relationship with many health care professionals. The home was recruiting to the vacant posts but the manager said that frequently the slow recruitment process lost them potential members of staff. The home had a strong recruitment procedure and the records indicated that it was implemented. Appropriate references, CRB and POVA checks were obtained before anyone was appointed to a post. The records that were inspected supported this. Howbury House DS0000037483.V252121.R01.S.doc Version 5.0 Page 15 The staff file that was inspected did not have a copy of the contract (Terms and Conditions of Employment). The manager explained that there was sometimes a considerable delay in receiving these from the department of Human Resources. The National Minimum Standard 29.5 states ‘All staff receive statements of terms and conditions’. Provision of these documents in a timely manner demonstrates that staff are valued by their employer. The provision of a contract to work demonstrates that staff are valued by their employer and is a requirement under standard 29.5 and employment law. A new design was being implemented for the recording of training. Staff had been given their old records and were transferring the information to the new format so they were not available for inspection. The manager said that fifteen staff were already qualified in NVQ and ten other staff were currently undergoing training. Staff were also undertaking training in ‘person centred planning’, equality and diversity, COSHH, food hygiene and risk assessing. Staff confirmed that they were encouraged and supported to undertake training. Howbury House DS0000037483.V252121.R01.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 38 Systems are in place to monitor the quality of the service provided and identify areas in need of improvement. The management of service users’ money provides security and safeguards their interests. Health and safety in the home is addressed through sound monitoring, servicing and training. EVIDENCE: The quality of the service was continuously monitored through feedback received from the service users and their relatives. Howbury House DS0000037483.V252121.R01.S.doc Version 5.0 Page 17 The manager said that every service user received a questionnaire at the end of their stay, that sought their opinion of the care and service they had received. An analysis of the results was then made available. Feedback from relatives and others was obtained in a less formal manner during reviews and from thank you letters and cards. A person was appointed by the provider to undertake the visits required by Regulation 26 and assess the service. Reports of these visits were provided to the manager, the Commission for Social Care Inspection, and the provider as required. The manager said that the home had an annual development plan and achieving the aims and objectives was proving more successful now that they had budget control. This can be seen through the improvements to the facilities and the strong commitment to improving the service that is provided. Service users were asked not to bring large sums of money to the home. However valuables could be held in safekeeping if required. Acceptable records were maintained and the flow of money was receipted. Each bedroom had its own lockable storage and if residents chose to retain responsibility for their money they signed a document to this effect. No health and safety hazards were observed. Monitoring and servicing was being carried out. The fire log and accident records were well maintained. Fire safety training was ongoing. The training questionnaires from the most recent training session had not been marked. The manager undertook to send the inspector a copy when the ‘marking’ had been done. Howbury House DS0000037483.V252121.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 2 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X x 3 Howbury House DS0000037483.V252121.R01.S.doc Version 5.0 Page 19 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 OP8 OP29 Good Practice Recommendations Service users must have a full and up to date assessment of their needs. This should include a nutritional, pressure care and moving and handling assessments. It is required that newly appointed staff receive a contract of employment in a timely manner. Howbury House DS0000037483.V252121.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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