Inspection on 01/02/06 for Howson Care Centre

This inspection was carried out on 1st February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Howson Care Centre 20/11/08

Howson Care Centre 22/11/07

Howson Care Centre 07/11/06

Howson Care Centre 04/07/05

Howson Care Centre 22/02/05

Howson Care Centre 21/06/04

Howson Care Centre 03/03/04

Howson Care Centre 24/07/03

Howson Care Centre 13/11/02

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Howson Care Centre Willingham By Stow Gainsborough Lincs DN21 3JZ Lead Inspector Mr Doug Tunmore Unannounced Inspection 1st February 2006 09:30 X10029.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 Howson Care Centre DS0000002539.V280895.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 and Care Homes for Adults 18 – 65*. 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. Howson Care Centre DS0000002539.V280895.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Howson Care Centre Address Willingham By Stow Gainsborough Lincs DN21 3JZ 01427 788283 01427 787567 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) Howson Care Centre Limited Mrs Carole Anne Horne Care Home 65 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (9), Learning disability (9), Mental disorder, of places excluding learning disability or dementia (22), Old age, not falling within any other category (25) Howson Care Centre DS0000002539.V280895.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide personal care with nursing for service users of both sexes whose primary needs fall within the following categories: Dementia (over the age of 65) DE(E) (9) Dementia (DE) (1) Learning Disabilities (LD) (9) Mental Disorder (excluding Learning Disability or Dementia) (MD) (22) Old Age, not falling into any other category (OP) (25) The one DE bed is used for the service user named in the notice of proposal dated 19 July 2005 The maximum number of service users to be accommodated is 65. 2. 3. Date of last inspection 4th July 2005 Brief Description of the Service: Howson Care Centre is situated at the edge of the village of Willingham By Stow and is set in landscaped grounds with car parking spaces to the front of the building. The home is owned by Howson Care Centre Limited and is managed by Mrs. C. Horne. The accommodations comprises of four areas; “The Flat” offers first floor accommodation to service users who have a Learning Disability, who are working towards supported living placements. “The Main House”, provides services to people with Mental Health problems. “The Wing”, provides accommodation to people with a Learning Disability. “The Court” provides both nursing and residential services to older people. Each unit is self-contained with its own kitchen, bathroom and lounge/ dining facilities. The kitchen in the main house area provides all meals and drinks and snacks can be prepared in the two smaller kitchen areas. The majority of the accommodation with the exception of “The Flat” area is situated on ground level comprises single and double bedrooms, some of which have en-suite facilities, 9 toilets, 4 bathrooms and 1 shower unit. The owner of the home visits weekly on a Thursday and works closely with the manager. Howson Care Centre DS0000002539.V280895.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced. The main method of inspection used was called case tracking, which involved selecting two residents and tracking the care they receive through the checking of their records, policies and procedures and discussion with them, the care staff and observations of care practice. The manager, staff and five residents spoken to were very open to the inspection. A partial tour of the premises took place. What the service does well: What has improved since the last inspection? What they could do better: There was no evidence found in this inspection that the following procedures or practices have been undertaken: 1. The nurse on duty has not signed medication sheets for medication given or not. 2. Risk assessments are not carried out on all those residents who self medicate. 3. Residents or their representatives have not signed care plans. Howson Care Centre DS0000002539.V280895.R01.S.doc Version 5.1 Page 6 4. Risk assessments are not available for those residents who carry food to the first floor. 5. The complaints form does not have a space for complainants to sign, signifying their satisfaction or otherwise with the outcome. 6. The home does not have an effective quality monitoring system, which seeks the views of residents. 7. Evidence was not available that hoists have been serviced. 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. Howson Care Centre DS0000002539.V280895.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Howson Care Centre DS0000002539.V280895.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The above standards were not inspected on this occasion. EVIDENCE: Howson Care Centre DS0000002539.V280895.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 9 & 10 Neither residents nor their representatives are involved in the care plans. The home does not administer medication appropriately. Residents privacy and dignity is respected in this home. EVIDENCE: Residents medication sheets were seen and it was found that the nurse in charge had not signed for medication given in the morning. Residents files seen did not have a risk assessment for those residents who self medicate. Residents had not signed those risk assessments that were available. Howson Care Centre DS0000002539.V280895.R01.S.doc Version 5.1 Page 10 However, resident’s files did show that residents had signed a self-medication form, taking responsibility for their own medication. A carer stated that a check is kept on those residents who self medicate to ensure that everything is in order. Four residents confirmed that they self- medicate The pharmacist inspected the home on the 25/11/05 and recorded that signatures had been missed on medication sheets. Residents care plans seen reflected the need to maintain residents independence in their daily lives and to respect the privacy and dignity of residents. The home has an intimate care policy, which informs carers of the need to maintain residents dignity when undertaking personal care tasks. The rota was seen and showed that both male and female staff are on duty to enable genders options to residents when undertaking personal care. Care plans did not evidence the involvement of residents and, or their relatives and were not signed by the resident or their representative. One resident said that she was not aware she had care plans and had not signed anything. Residents stated that ‘they get on ever so well with staff, who are polite and knock on our doors before coming in’. Howson Care Centre DS0000002539.V280895.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 & 15 Residents are supported in maintaining their independence. The home provides a balanced and nutritious diet for residents. EVIDENCE: Care plans seen identified those areas in which residents need prompts in order to maintain their independence. Risk assessments were seen and identified the risks and level of supervision required for individual residents. Residents in the flat are consulted on a weekly basis about maintaining their daily living skills by undertaking in house chores as well as looking after their personal hygiene needs. Howson Care Centre DS0000002539.V280895.R01.S.doc Version 5.1 Page 12 Residents stated that they look after their own rooms and carry out tasks with the flat, hovering, washing dishes and washing their own clothes. They felt in charge of their own lives and enabled to make choices regarding their daily living. A carer stated that one resident has asked for a breakdown of her finances and this was given to her. The inspector joined five residents for lunch and found the meal provided to be hot and delicious. Residents said that they have a choice of meals and they look forward to meal times. However, the food is carried upstairs to the first floor by carers and residents, this poses a risk and an assessment of this practice must be undertaken to determine the risk to individual residents. It was suggested that a sealable lightweight container should be used for transporting food. Howson Care Centre DS0000002539.V280895.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Residents are not empowered by the homes complaints procedure. EVIDENCE: The complaints form was seen and it was found that there was a place for a complainant to sign to signify whether they agreed with the outcome or not. Resident confirmed that ‘they had no complaints and that staff were approachable and are alright’. The manager stated that she and her deputy had attended complaints training Course called ‘ Why complaints are good for your business’ some two years ago. Howson Care Centre DS0000002539.V280895.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 Residents living at the home live in a clean, comfortable and warm environment. EVIDENCE: The homes cleaning rota was seen and showed that there are six cleaners who work seven days a week, two being full time and the rest working in the mornings. One cleaner works over the weekend period. Residents seen in the flat confirmed that they undertake cleaning tasks, which are agreed together as a group every week. The home was clean and tidy with no offensive odours. Howson Care Centre DS0000002539.V280895.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the 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 Appropriate recruitment practices are in place. Staffing level meets the needs of residents. EVIDENCE: Two personnel file seen contained CRB checks (Criminal Record Bureau), references and application forms. All care workers have seen The General Social Care Council Codes of Practice, which sets out their responsibilities as care workers looking after vulnerable adults. The homes rota was seen and showed that usually ten staff are on duty during the day with two trained nurses. On the day of the inspection one carer was unavailable to work and a trained nurse made up the numbers. The home has ancillary workers, which include; a handy man, two cooks, two kitchen assistance, two part time laundry workers and a hostess who ensures that residents get liquid refreshment throughout the day. The staff rota also showed that there is one trained nurse and five carers on duty during the Howson Care Centre DS0000002539.V280895.R01.S.doc Version 5.1 Page 16 night. A carer commented that the current staffing levels enables the home to meet the needs of residents living in this home. One care worker demonstrated a clear understanding of her role and responsibilities. Residents stated that ‘ a lot of staff are on in the day time and that at night there are four staff and one nurse’. Howson Care Centre DS0000002539.V280895.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) 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 The home is not pro-active in fully involving residents in quality monitoring audits. Residents monies are kept safe by the homes financial procedures. Appropriate checks are not carried out to ensure the safety of residents. Howson Care Centre DS0000002539.V280895.R01.S.doc Version 5.1 Page 18 EVIDENCE: The manager commented that residents meetings are carried out with those residents who live in the flat. Records were also seen that staff meetings are also carried out in the home. The manager confirmed that that home does not undertake audits, which should include the views of residents or visitors. The home only deals with personal allowances of residents, which are kept at the home. All other monies relating to funding are paid into the companies bank account on a standing order, direct debit or by check by relatives or the County Council. Some relatives keep residents personal allowances and the home invoices them when further monies are required. Some seventeen residents are able to sign for the personal allowances and lockable facilities are available in their rooms. There are a range of policies and procedures available in the home relating to fire safety and fire risk assessments. There was also evidence that fire alarm, fire drill and emergency lighting checks are carried out. Staff also receive fire training as part of the homes initial training. Certificates were available showing that gas safety inspections have been carried out, legionella checks, electrical wiring checks, portable electrical equipment checks and that hoists had been service in the last six months. Howson Care Centre DS0000002539.V280895.R01.S.doc Version 5.1 Page 19 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 x 2 x 3 x 4 x 5 x 6 x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x ENVIRONMENT Standard No Score 19 x 20 x 21 x 22 x 23 x 24 x 25 x 26 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No Score 31 x 32 x 33 2 34 x 35 3 36 x 37 x 38 3 Howson Care Centre DS0000002539.V280895.R01.S.doc Version 5.1 Page 20 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 YA20OP9 Regulation 13 (4)(c) Requirement The Registered Persons must ensure that risk assessments are in place for those residents who self medicate. The home must ensure that medication is signed for at the time it is given to ensure that there is no confusion as to who has been given their medication or not. The home must carryout and keep a record of the spot checks carried out on medication held by service users who self-medicate, along with the results of the check and any action taken. The home must ensure that consultation with residents and relatives is undertaken and that care plans are signed to confirmed agreement on the personal care to be delivered. The home must carry out risk assessments for those residents who carry food from the kitchen to the first floor. The home must carryout quality DS0000002539.V280895.R01.S.doc Timescale for action 25/03/06 2 YA20OP9 13(2) 25/03/06 3 YA20OP9 13(2) 25/03/06 4 YA18OP10 15 25/03/06 5 YA17OP15 13(4)(b) 25/03/06 6 YA39OP33 12(3) 25/03/06 Page 21 Howson Care Centre Version 5.1 monitoring audits based on the views of residents and visitors. 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 YA17OP15 Good Practice Recommendations The home should use appropriate carriers for the safe moving of residents meals and to keep them warm from the kitchen to the first floor flats. Howson Care Centre DS0000002539.V280895.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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. Howson Care Centre DS0000002539.V280895.R01.S.doc Version 5.1 Page 23 - 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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