CARE HOMES FOR OLDER PEOPLE
Ingham Old Hall Residential Care Home Sea Palling Road Ingham Norwich NR12 0TW Lead Inspector
Linda Wells Unannounced 12 May 2005 11:30 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. Ingham Old Hall Residential Care Home I55 s63055 Ingham Old Hall v225804 (un) 120505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Ingham Old Hall Residential Care Home Address Sea Palling Road Ingham Norwich Norfolk NR12 0TW 01692 580257 01692 580297 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) Ingham Healthcare Ltd Ms Helen Hill (awaiting registration) Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Ingham Old Hall Residential Care Home I55 s63055 Ingham Old Hall v225804 (un) 120505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31 January 2005 Brief Description of the Service: Ingham Old Hall is a residential care home providing personal care and accommodation for up to twenty-five older people. It is a detached, two storey, period house that has retained many of its origional features and in parts dates back to the fourteenth century. There is a passenger lift to the first floor and residents have communal use of a lounge, entrance hall sitting area, conservatory and dining room. The home has twenty-four bedrooms, one of which is a double bedroom and all have ensuite or designated washing and toilet facilities. There is a communal toilet and bathroom on each floor with a shower facility on the first floor and an additional toilet on the ground floor. The home is privately owned and is situated in a rural setting in its own, large, well kept grounds with parking to the side of the building. The village of Ingham is approximately 1.5 miles from the small town of Stalham which offers shopping and health care amenities. Ingham Old Hall Residential Care Home I55 s63055 Ingham Old Hall v225804 (un) 120505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken on the 12th May 2005 over three and a half hours and was carried out as part of a routine inspection plan. Not all of the standards were assessed on this occasion and where a standard has been inspected, the complete range of elements, as set out in the National Minimum Standards, may not have been assessed. The score given represents those aspects viewed on the day. Since the last inspection a new proprietor has purchased the home and employed a manager who had been in post for two weeks at the time of inspection. Prior to the change in proprietor an anonymous complaint was received by the Adult Protection Unit alleging poor work practice and disrespectful behaviour of a member of staff and this complaint was upheld. On the day of inspection residents were seen to be sitting in the lounge, the garden or their bedrooms reading or watching television and the manager had arranged and held a staff training session on customer care. The inspection took the form of a tour of the premises, individual discussion with four residents, four staff members, the manager and the proprietor, examination of care plans, records, certificates and compliance and recommendations from the last inspection. What the service does well:
The home has a friendly, relaxed atmosphere and the four residents spoken to said that they liked living at the home, they were well looked after, that the staff treated them with respect and assisted them with all necessary tasks in a kind and considerate manner. They felt that the routine of the home could be flexible, the meals were good and that the home was always clean and tidy. Residents are well looked after and staff members put the needs of each resident first. The four staff members spoken to said that they enjoyed working in the home, that the home was run as a family home and that they were encouraged to promote independence. Ingham Old Hall Residential Care Home I55 s63055 Ingham Old Hall v225804 (un) 120505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
The new proprietor and manager have inherited information, systems and work practice routines that do not fully meet and protect the needs of those that live in the home and both spoke of their plans to introduce better working and recording systems that would ensure that residents received the highest standard of care and that staff were supervised and supported. Areas in need of improvement are The information held on each resident in their plan of care was incomplete and did not ensure that they were receiving the necessary health and social care, nor were residents consulted and fully protected. The home is not well maintained in all internal areas and requires redecoration and re-carpeting in some parts of the home. The proprietor spoke of his plans to achieve this. The health and safety of those that live and work in the home is not fully protected due to some radiators in the home not being covered. They must be removed or guarded. The recruitment, training and management of staff did not fully protect residents because all checks on staff had not been undertaken, records were not held and staff had not completed all basic training or received supervision. Residents, family members and visitors were not included and consulted and this resulted in feedback not being sought on the opinions of the quality of care provided. Ingham Old Hall Residential Care Home I55 s63055 Ingham Old Hall v225804 (un) 120505 Stage 4.doc Version 1.30 Page 7 Records maintained in the home did not protect residents, inform staff and were not secure and well organised. 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. Ingham Old Hall Residential Care Home I55 s63055 Ingham Old Hall v225804 (un) 120505 Stage 4.doc Version 1.30 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 Ingham Old Hall Residential Care Home I55 s63055 Ingham Old Hall v225804 (un) 120505 Stage 4.doc Version 1.30 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 and 3 The admission procedure and written information available is not adequate and does not fully enable residents and staff to make a decision on whether the home will meet the needs of anyone wishing to live there. EVIDENCE: Prior to admission to the home an assessment is carried out to ensure that the needs of residents are identified as being able to be met by the home and includes the views of residents, their families and other professionals. However, none of the information available is complete or accurate and a new admission procedure, Statement of Purpose and Terms and Conditions Contract must be produced that will inform the reader, aid decision-making and contain the relevant information. Ingham Old Hall Residential Care Home I55 s63055 Ingham Old Hall v225804 (un) 120505 Stage 4.doc Version 1.30 Page 10 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) 7,9 and 10 The health, personal and social care needs of residents were met, they were well looked after, but records were not up to date and stored in the plan of care. EVIDENCE: The information held on each resident was incomplete and not stored together. Four individual plans of care were examined and found to contain some relevant health and social care information but all records must be kept in the plan of care, stored safely, signed and dated, a photograph held on each resident, risk assessments completed, weight records kept, daily records maintained and monthly reviews undertaken to ensure that the healthcare needs of each resident is met and to demonstrate involvement, consultation and agreement of each resident on their plan of care. Medication policies and procedures protected residents, staff had undertaken training and medication was stored, administered and recorded correctly. Those that lived at the home were treated with respect and the four residents spoken to all felt that staff members protected their privacy when they were assisted with personal care.
Ingham Old Hall Residential Care Home I55 s63055 Ingham Old Hall v225804 (un) 120505 Stage 4.doc Version 1.30 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 and 15 The social and creative activities and meals provide daily variation and interest for those living at the home. EVIDENCE: There were planned activities that residents said they enjoyed and one resident spoken to gave examples of walking her dog in the grounds and organising sing songs with other residents to pass the time. One resident spoken to felt that she did not like to mix with others and was pleased to tell the inspector that staff respected her wish not to join in with activities. The residents all felt that they enjoyed the meals and the cook explained that the choice of meal was discussed with each resident and alternatives offered each day to ensure individual preferences were catered for. The menus were inspected and found to be wholesome, varied, balanced and that records were kept of the alternative any resident choose to aid in the monitoring of the nutritional health of each resident. Ingham Old Hall Residential Care Home I55 s63055 Ingham Old Hall v225804 (un) 120505 Stage 4.doc Version 1.30 Page 12 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 home’s complaints system is poor and does not fully protect residents. However, residents feel that their views are listened to and acted upon. EVIDENCE: The residents spoken to by the inspector all agreed that if they had reason to complain they would speak to staff or the manager and all felt confident that the problem would be resolved quickly and to the satisfaction of all involved. The proprietor and manager recently took over the management of the home at the conclusion of an investigation into an anonymous complaint received by the Adult Protection Unit and passed to the inspector at CSCI. It was alleged that a member of staff treated some residents and staff disrespectfully and had poor work practice at times. The allegations were proven and the staff member was placed on the POVA list as unsuitable to work with frail people. Residents are not fully protected because not all staff have completed training in Adult Abuse and are aware of the whistle blowers policy. All staff must complete this training. Ingham Old Hall Residential Care Home I55 s63055 Ingham Old Hall v225804 (un) 120505 Stage 4.doc Version 1.30 Page 13 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, 21, 24, 26 The standard of the environment within this home is mainly good providing residents with an attractive and homely place to live. EVIDENCE: A tour of the building revealed that the home was clean, odour free, homely and furnished and decorated to a good standard. The exception was the hallways on both floors and some bedrooms that were in need of redecoration and re-carpeting. The proprietor said that he planned to gradually refurbish each bedroom as it became vacant and to redecorate all areas of the home. The home has sufficient and suitable toilet and washing facilities and service users had personalised their bedrooms. All infection control measures were in place and the laundry room contained a service washing machine, tumble dryer and sluicing facility to aid in the protection of the health and safety of all residents and staff. The Health and safety of residents was not fully protected and all radiators on the heating system must be guarded or removed.
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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) 29 and 30 The procedures for the recruitment and training of staff were not robust and do not provide adequate safeguards to protect people living at the home. EVIDENCE: Residents are not fully protected and although written procedures were held they had not been followed resulting in poor practice. Examination of staff records highlighted that although individual staff files had been compiled and staff checks carried out they were incomplete. Not all staff documentation was kept showing proof of identity, two references and relevant CRB checks and the proprietor said that the manager would be working to improve the staff files inherited from the previous manager and all staff checks carried out. The correct individual staff checks, personal information and documentation must be kept to ensure the protection of those living in the home. Training was incomplete, not planned or full records kept and resulted in staff members not being fully up to date and equipped to meet the range of needs of residents. The staff spoken to gave examples of the training they had recently completed such as senile dementia, first aid and moving and handling but staff induction and foundation training was incomplete and resulted in staff still waiting to complete basic training after being in post for two years. The staff expressed enthusiasm to undertake training and said that the new manager had informed everyone of her plan to increase the training available to staff but all staff must complete basic and foundation training. Ingham Old Hall Residential Care Home I55 s63055 Ingham Old Hall v225804 (un) 120505 Stage 4.doc Version 1.30 Page 15 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) 33, 36, 37, 38 There are no complete systems, record keeping, policies and procedures and individual care needs will not be fully met until the manager is able to set clear expectations through supervision. EVIDENCE: The best interests and rights of residents are not fully promoted because residents and visitors to the home are not consulted or feedback sought on the quality of care and facilities provided and a quality assurance system must be implemented. The systems, Record keeping and policies and procedures do not fully safeguard the rights and best interests of those living and working at the home and must be produced, organised and updated to ensure they are complete and stored safely. The daily, verbal handover does not fully support staff and ensure that they are informed on the needs of each resident and all aspects of the home.
Ingham Old Hall Residential Care Home I55 s63055 Ingham Old Hall v225804 (un) 120505 Stage 4.doc Version 1.30 Page 16 Handover records must be kept and be available to staff to enable feedback and changes in the care needs and the routine of each resident to be known to staff. To ensure that residents are fully protected staff members must receive supervision to review their work practice, clarify the aims and objectives of the home, the care provided to each resident and to identify, plan and review their training needs. The servicing and testing of all equipment in the home has been carried out and relevant and timely certificates were held to ensure that the health and safety of residents is protected. The manager has been in post for two weeks and an application form for registration as the manager of the home is being completed. Ingham Old Hall Residential Care Home I55 s63055 Ingham Old Hall v225804 (un) 120505 Stage 4.doc Version 1.30 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. 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 2 2 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 2 x 3 x x 3 x 3 STAFFING Standard No Score 27 x 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 x x 1 x x 1 2 2 Ingham Old Hall Residential Care Home I55 s63055 Ingham Old Hall v225804 (un) 120505 Stage 4.doc Version 1.30 Page 18 YES 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. 2. 3. Standard OP1 OP2 OP3 Regulation 4.1.c schedule 1 5.1-3 14.1 2 Requirement The proprietor must ensure that a Statement of Purpose is produced. The proprietor must ensure that a Service user Guide is produced. The proprietor must ensure that a full assessment is carried out on each service user prior to admission to the home and records held in the plan of care. The proprietor must ensure that all information is held in the plan of care as listed in schedule 3. The proprietor must ensure that a complaints procedure is produced. The proprietor must ensure that all staff complete training in Adult Abuse. The proprietor must ensure that a record of planned maintanence, redecoration and refurbishment is produced and implimented. The proprietor must ensure that all recruitment checks are carried out and records held on each staff member. The proprietor must ensure that all staff complete Induction and Timescale for action 1st September 2005 1st September 2005 1st July 2005 4. 5. 6. 7. OP7 OP16 OP18 OP19 17.1.a schedule 3 22.1-8 13.6 23.2.b 1st July, 2005 30th June 2005 1st July 2005 31st July 2005 and ongoing 31st July 2005 31st September
Page 19 8. OP29 19.1-5 schedule 2 18.1.C.i 9. OP30 Ingham Old Hall Residential Care Home I55 s63055 Ingham Old Hall v225804 (un) 120505 Stage 4.doc Version 1.30 10. 11. OP33 OP36 24.1.a b, 2 3 18.2 12. OP37 17.2 schedule 4 13.4.c 13. OP38 Foundation training and records are kept. The proprietor must ensure that a Quality Assurance system is in place. The proprietor must ensure that all staff receive regular supervision and records are kept. The proprietor must ensure that policies and procedures are produced on all aspects of safe working practice in the home. The proprietor must ensure that all radiators on the heating system are guarded or removed. 2005 1st October 2005 1st July 2005 and ongoing. 31st September 2005 1st August 2005 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 OP37 Good Practice Recommendations It is recommended that the daily handover be recorded in a format that is accessible to all staff. Ingham Old Hall Residential Care Home I55 s63055 Ingham Old Hall v225804 (un) 120505 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection 3rd Floor - Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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