CARE HOMES FOR OLDER PEOPLE
Howbury House Pickersleigh Grove Malvern Worcestershire WR14 2LU Lead Inspector
Yvonne South Final - Unannounced Inspection 18 April 2005 10:00 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. Howbury House E52 S37483 Howbury House V220226 180405.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Howbury House Address Pickersleigh Grove Malvern Worcestershire WR14 2LU 01684 571750 01684 571753 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) Worcestershire County Council Mrs Patricia Averil Ball Care Home 36 Category(ies) of Dementia - over 65 years of age - 20 registration, with number Old Age (not falling within any other category) of places - 36 Physical Disability over 65 years of age - 36 Howbury House E52 S37483 Howbury House V220226 180405.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home may provide intermediate care for a maximum of 16 service users whose needs are in categories OP and PD/E. 2. The home may also provide this intermediate care to service users over the age of 60 who have a physical disablity. 3. The home may accomodate one person under the age of 60 years for intermediate care. Date of last inspection 5 January 2005 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 thirty-three older people with physical and/or mental health needs in the form of respite, assessment and rehabilitation. There are currently only three permanent service users resident in the home. 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 E52 S37483 Howbury House V220226 180405.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over four hours and was the first inspection to be undertaken during the year 1st April 2005/31st March 2006. A partial tour of the premises was undertaken. Eight service users and four staff were spoken to. Records for two service users, the fire log and the complaint record were seen. What the service does well: What has improved since the last inspection?
Although the information was brief and there were some omissions there had been an improvement in the quality of the care records since the last inspection, and a method of monitoring the participation of staff in fire safety training had been developed. The Occupational Therapist had settled into her role and become a valued member of the team. Howbury House E52 S37483 Howbury House V220226 180405.doc Version 1.20 Page 6 New equipment had been purchased and plans made for the building of a new meeting room and storage facilities. This would be followed by redecoration and re-carpeting of corridors. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Howbury House E52 S37483 Howbury House V220226 180405.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Howbury House E52 S37483 Howbury House V220226 180405.doc Version 1.20 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 standard(s) 3 & 6 The assessment process ensured the needs of people admitted to the home could be met. EVIDENCE: Four people, whose abilities were being assessed, could not recall why they were in the home but four other people receiving respite care knew why they were in there. Staff indicated that they were aware of the service user’s needs and had access and input to the individual records were kept for each of the person staying in the home. Two sets were inspected and they contained detailed pre admission assessments undertaken on behalf of the home. Howbury House E52 S37483 Howbury House V220226 180405.doc Version 1.20 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 standard(s) 7, 8, 9 and 10 There were clear care plans that provided staff with information that enabled them to meet the needs of the people staying in the home. The health needs of service users were well met by care staff with good multi disciplinary support. Medication was well managed. Pressure care, moving and handling and nutritional assessments were not routinely carried out so information was not available on which to base a relevant care plan. Service users were treated with respect and their privacy was upheld. EVIDENCE: Service users were unaware of the meaning of the term ‘care plan’ but they were aware that records relating to them were kept. Service users had signed the care plans in the two files inspected. Staff were able to locate and use the individual files.
Howbury House E52 S37483 Howbury House V220226 180405.doc Version 1.20 Page 10 There were moving and handling concerns relating to two people but assessments had not been undertaken so care plans could not be drawn up. The registered manager said that if concerns arose regarding nutrition and pressure care the dietician and district nurses were consulted. However nutritional and pressure care assessments were only undertaken in detail if concerns were identified. There was no indication how this decision was made. Service users said that they were well looked after. The records indicated that doctors and district nurses had been consulted. A physiotherapist and occupational therapist worked in the home and a doctor and a district nurse were visiting their patients during this inspection. Medication was well managed either by the service user or the staff, dependent on a risk assessment. A member of staff confirmed that she had received training in the home from a senior member of staff. The manager said that the training had been confirmed as acceptable by the Commission for Social Care Inspection pharmacy inspector. Medication trolleys were available for each unit in the home and they were all safely secured. The occupational therapist provided detailed written guidance to enable staff to assist service users in her absence. A more individual and private method of recording was discussed. The service users said that the staff were kind and they were seen to be addressed courteously and assisted by the staff when necessary. Howbury House E52 S37483 Howbury House V220226 180405.doc Version 1.20 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 Opportunities were provided for service users to participate in a range of activities and interests. Community links were maintained. They had a good choice of well-prepared meals and special diets were provided when needed. EVIDENCE: The people in the home gave examples of the activities they could participate in if they chose. The staff confirmed that a programme was available and records were maintained. Details of interests were entered on care plans. The service users confirmed that visitors were welcome and it was observed that a community hairdresser was providing a service for some people. The cook confirmed that he frequently sought feed back from the people in the home. On admission he met everyone and recorded their dietary needs and likes and dislikes. The manager said that, if concerns were identified, a dietician carried out a full nutritional assessment and people were weighed. It was observed that the main meal of the day was appetising and attractively served.
Howbury House E52 S37483 Howbury House V220226 180405.doc Version 1.20 Page 12 Service users were most complimentary regarding the choice and quality of the meals provided. Howbury House E52 S37483 Howbury House V220226 180405.doc Version 1.20 Page 13 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 The service users were given information and support to enable them to raise their concerns when they wished and they were protected from abuse. EVIDENCE: The service user’s files contained a complaints procedure. This document needed to have the address of the Commission for Social Care Inspection updated. People said that if they had concerns they would raise them through their family members or supporters, or directly through the staff. Three service users said that they had no complaints. One person complained that she had not made the progress that she wished during her stay. This was discussed with the manager. Progress had been made and the records supported this. Support continued to be given to increase the lady’s confidence and self-esteem. Appropriate policies and procedures were being implemented to protect vulnerable people. Action had been taken when a concern had been raised. The complaint record indicated that there had been a concern relating to the attitude of a member of staff. This had been investigated and appropriately addressed by the manager. The complaint was upheld. Howbury House E52 S37483 Howbury House V220226 180405.doc Version 1.20 Page 14 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) These standards were not assessed during this inspection. EVIDENCE: Howbury House E52 S37483 Howbury House V220226 180405.doc Version 1.20 Page 15 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) These standards were not assessed during this inspection. EVIDENCE: Howbury House E52 S37483 Howbury House V220226 180405.doc Version 1.20 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 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) 38 Fire safety was the only aspect of health and safety inspected during this inspection. Routine fire safety checks and fire safety training contributed to maintaining a safe environment. EVIDENCE: The records indicated that checks were being undertaken at the advised frequency and action had been taken when necessary to address concerns that were identified. The routine testing of the fire alarms and fire door closures took place during the inspection. The manager said that fire safety training was being undertaken with all staff. However the monitoring record had not been maintained.
Howbury House E52 S37483 Howbury House V220226 180405.doc Version 1.20 Page 17 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x x Howbury House E52 S37483 Howbury House V220226 180405.doc Version 1.20 Page 18 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 8 Regulation 14, 17 Requirement Assessments of moving and handling, pressure care and nuitrition must be undertaken in order to identify needs and plan care. The complaint procedure must contain accurate information relating to the Regulatory Authority. Timescale for action 1st October 2005 2. 16 22 30th April 2005 3. 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 Good Practice Recommendations Howbury House E52 S37483 Howbury House V220226 180405.doc Version 1.20 Page 19 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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