CARE HOMES FOR OLDER PEOPLE
Inglewood Residential Care Home 139 Dalston Road Carlisle Cumbria CA2 5PG Lead Inspector
Diane Jinks Unannounced Inspection 18th July 2007 09:30 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 Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 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. Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Inglewood Residential Care Home Address 139 Dalston Road Carlisle Cumbria CA2 5PG 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) 01228 526776 Mrs Sylvia June Clark Mrs Sylvia Lynn Bendle Care Home 26 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (24), of places Physical disability (1) Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30th November 2006 Brief Description of the Service: Inglewood is a care home providing residential care for up to 25 older adults. The home is an older property, which has been adapted for its present use. It is situated approximately one mile from the city centre. The accommodation is provided on two floors, and there is a passenger lift and stair lift. There is one double bedroom; the remaining rooms are for single occupancy. A large number of the bedrooms have en-suite toilet facilities. There are bathrooms and a new shower room, which are equipped to assist people with a disability. There are two communal lounges and a dining room. There is a designated area for people who wish to smoke. The home has a pleasant garden to the front of the home with seating and there is a small car park. The manager has produced information booklets about the services the home can provide and a copy of the latest inspection report is available at the home. Both these documents are available from the manager on request. The scales of charges are from £371.00 to £420.00 per week. Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The assessment of this service took place over several weeks. The site visit to the home was completed in one day. The home was assessed against the National Minimum Standards for care homes. During the visit people living at the home were spoken to, staff working at the home were also spoken to. Some people and their relatives were sent questionnaires in order to obtain their views of the service. The discussions and questionnaires help to provide information about the home. The manager also completed an Annual Quality Assurance Assessment; this helped to verify information throughout the assessment of this service. What the service does well: What has improved since the last inspection? What they could do better:
Although some improvements have been made to the social and leisure activities available at the home, further improvements could be made. This will help ensure that people living at the home are not left alone for long periods in front of the television. There are also some gaps in the staff recruitment process, which need addressing to ensure that staff are properly checked before they are employed at the home. Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 Page 6 There are some areas of the home that would benefit from cleaning and renovating and this was discussed with the manager. 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. The summary of this inspection report can be made available in other formats on request. Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 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 Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3. (Standard 6 is not applicable) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home have had their care needs assessed prior to them moving into the home. This helps to ensure that the home will be the right place for them and will be able to meet their needs and expectations. EVIDENCE: The Statement of Purpose and Service User Guide have been updated. A brochure has been produced to give a summary of the home and the services that it can provide. Some of the people living in the home were spoken to during the visit. Most had been able to visit the home prior to moving in but some people had moved in from hospital or where their relatives had made the arrangements on their behalf. All of them indicated that they had been provided with sufficient information about the home to help them make a decision. The manager indicates that the admission policy and procedures at the home have been reviewed and updated. Staff are made aware of the admission process as part of their induction training.
Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 Page 9 Samples of care files were looked at during this visit. All of them contained care needs assessments that had been undertake by social services or the primary care trust where applicable. The manager at the home also carries out an assessment of the persons care needs, prior to their admission to the home. Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home have detailed plans of their care needs. This helps to ensure that appropriate care and support is provided to people living at the home. EVIDENCE: The samples of care files looked at contain detailed care plans and information about the person’s care needs. Care plans identify areas that the person may need help with. Expected outcomes are recorded and the person’s independence was recognised and encouraged throughout the care plan. People spoken to know that they have a plan for their care and support needs. They indicate that they are consulted when the care plan is being updated or reviewed. The staff spoken to are very familiar with the care plans. They are encouraged to read them, keep them up to date and monitor their effectiveness. Daily records are also written and include information of significant events, where the doctor may have been called and appointments at the hospital, opticians or clinic have been undertaken.
Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 Page 11 Records also show that people living at the home have access to a range of health care professionals such as district nurses, opticians, dentists, chiropodists, speech and language therapists and physiotherapists. Nutritional screening is undertaken on admission to the home. Where concerns are identified these are monitored and the dietician is called for advice and support. People who do not cause concern regarding their nutritional intake have their weights monitored each month – this helps to identify any issues at an early stage. There is a medication policy and procedure in place at the home and staff training records show that training in the administration of medication takes place. Medication was stored securely on the day of the visit to this home. A fridge has been obtained for medicines requiring cold storage and there are suitable arrangements in place for medicines that require extra secure storage and recording. The medication records looked at on the day of the visit had been accurately completed. There is a process in place at the home for recording medication received into the home and returns to the pharmacy. The pharmacist checks and signs for returned medication. Photographs of the people living at the home are included on the medication boxes to assist with identification and improve safety. Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home tries to provide social and leisure activities for the people living at the home, which generally meet the needs of most people. Improvements could be made to ensure that the needs of differing genders are catered for. EVIDENCE: The records looked at show that people are generally able to exercise some control and choice over their lifestyle. Some of the people living in the home said that they are able to make choices about their meals, bathing and showering and also when they get up or go to bed. Some people like to get up later in the morning and this was seen on the day of the visit. Care files show that the manager has ensured people living in the home are included in the electoral register and where postal votes are required, she has ensured this has been attended to. Care plans briefly address social interests, skills and hobbies and this could be improved upon, particularly in the case of the men who live at the home. The manager said that ideally she would like to employ a dedicated activities coordinator to help make improvements to the leisure and social activities available at the home.
Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 Page 13 The home has produced a newsletter and a variety of themed party nights are planned each month. BBQ’s have been held in the garden at the home and trips out have been arranged. Entertainers are also brought into the home. A record of activities and the people participating is kept at the home. Activities include church services, knitting, bingo, videos, baking, croquet, dominoes and cards. Some of the residents spoken to talked about the theme party nights and the BBQ, which they had enjoyed. On the day of this visit I sat in one of the lounges for two hours looking at care files and records. Very little stimulation or interaction was provided for the people sitting in this lounge during this time span. Menus and food choices have been discussed at residents meetings and people living at the home said that the food was good. One person said ‘the food is beautiful and there is always a choice’. The serving of the lunchtime meal was observed during this visit. Good size portions were served. The dining room was set out nicely and people were enjoying their meals and chatting. Where assistance was needed this was undertaken by staff in a sensitive and respectful manner. Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are protected from harm or abuse. They are encouraged and enabled to voice their opinions or concerns in a variety of ways and are confident that they will be taken seriously and listened to. EVIDENCE: The home has not received any complaints since the last visit to this service. Copies of the home’s complaints process are available throughout the home and people are given a copy of the process when they move into Inglewood. The Statement of Purpose also contains a copy of the complaint process. Contact details are included for Commission for Social Care Inspection and the local Adult Social Care team so that people are aware of who they may also direct their concerns/complaints to if they wish. Residents meetings are held and relatives are also able to attend these meetings. This helps to provide a forum for people living in the home to discuss matters about life in the home. Staff are made aware of the complaint procedure as part of their induction training. There are policies and procedures in place to help ensure the protection of vulnerable adults and staff have received training on this subject. The manager has recently undertaken a training course to help her instruct staff on this subject. Discussions with staff indicate that they are aware of the procedure to follow should they suspect that someone is being mis-treated. Both the staff and people living at the home are confident that the manager
Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 Page 15 would take such allegations seriously and deal with them appropriately should this ever occur. The manager has obtained information regarding the protection of adults and this is available throughout the home. A copy of the local authority’s MultiAgency procedures and guidelines has also been obtained. This will help ensure that should suspicions or allegations of abuse be raised with the manager, the correct process will be followed to keep the person concerned safe. Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 21 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally maintained to a good standard. People at the home live in warm and comfortable surroundings. EVIDENCE: Several areas of the home have recently been redecorated and new carpets have been fitted. New central heating and hot water boilers have been fitted. There are two lounge areas in the home, which are well furnished, warm and comfortable. A conservatory leads off one of the lounges but this is not currently in use and is due to be refurbished in August 2007. The bedrooms are generally well maintained and people are able to bring items of their own furniture and other items in order to personalise their rooms and help make them homely. Many of the rooms have en-suite toilets and washbasins. The dining room is bright and clean and provides a pleasant environment at mealtimes.
Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 Page 17 There were some odours detected in some of the bedrooms downstairs and in the sluice room on the first floor. The sluice room is in a poor state and requires clearing and cleaning. There are bath and shower facilities throughout the home and these rooms are warm and well maintained. There are facilities available to assist people with mobility problems to access the baths and showers. A passenger lift and a stair lift are available to help people with limited mobility. The home has a designated smoking area for use only by the people who live at the home. This area does not appear to meet the recent requirements and legislation regarding smoking areas. The manager was advised to contact the relevant people (Carlisle City Council) to check this so that suitable arrangements can be put in place if necessary. One of the downstairs bedrooms has been renovated and converted into a smart recreation/visitors room. People living at the home are able to use this room whenever they wish. There are facilities in here for making drinks and light refreshments are available. Extensive gardens around the home are well maintained. People living at the home are able to access the gardens in the better weather. The home holds barbecues in the gardens in the warmer weather. Some of the people living at the home said that they enjoyed these very much. Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are generally supported by staff that are trained and experienced in meeting their needs appropriately. EVIDENCE: Samples of staff employment and training files were looked at during this visit to the home. The sample included recently recruited staff and night staff. Application forms are completed and a record of the interview is kept. Prospective staff undergo Criminal Record Bureau (CRB) checks and Protection of Vulnerable Adults (POVA) list checks. One person did not have a valid CRB certificate and this was discussed with the manager. She was advised to obtain a new check in respect of this person and ensure that the recruitment procedure was revised in line with current legislation. Two references are obtained for each prospective member of staff and employment histories are thoroughly checked. Staff undertake induction training, which includes shadowing another member of staff and detailed records are kept. Further training is provided and again detailed records are maintained. Training includes; adult protection, fire training, medication, palliative care, food hygiene, first aid, manual handling, diabetes awareness, National Vocational Qualifications (NVQ’s) and infection control. Night staff have undertaken manual handling, fire and food hygiene training and would benefit from further training to help ensure that the needs of the people living at the home are met appropriately at all times.
Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 Page 19 Training is provided by various methods including distance learning courses, external training providers and in-house courses. On the day of the visit there appeared to be sufficient staff on duty, although the cook was off and one of the care staff cooked the lunch. The home employs domestic and laundry staff to help ensure that care staff are not diverted from their duties in providing care to the people who live at the home. Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an experienced and qualified manager at the home who ensures that the home is generally operated in the best interests of the people living there. EVIDENCE: An experienced and qualified manager runs the home, assisted by a deputy and two senior carers all of whom have gained NVQ level 4. They have also undertaken the registered managers award. The manager consults with relevant professionals such as district nurses and dieticians when advice or assistance is needed. Much work has been carried out at the home to ensure that improvements to the service have been made. Plans are in place to ensure that staff are kept up to date with developments in health and social care, including further training. There is a quality assurance process in place and people living at the home are able to voice their opinions in a variety of ways, including via the residents
Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 Page 21 meetings which have been set up. The home produces a newsletter to help keep people and their visitors/relatives up to date with events at the home. The home is currently not responsible for the safe keeping of any monies belonging to people living in the home. This is usually managed by their friends or relatives. Staff records show that they are regularly supervised and have their work practices observed. This helps to ensure that people are supported by suitable and competent staff. It also helps the manager identify any training needs that staff might have to help them in their care roles. There is a maintenance plan in place at the home. This helps to ensure that the general environment and equipment available at the home is kept in good order and safe. A new central heating system has been installed at the home and the home has recently had the electrical installations inspected. Staff are provided with health and safety training, first aid training and there are procedures and protective clothing in place to help ensure the control of infection. On the day of the visit there were one or two matters that required the managers attention, particularly the use of protective clothing in relation to food hygiene matters and the condition of the sluice room on the first floor. Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 Page 22 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 3 X 3 X X N/a 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X X X X 2 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/a 3 X 2 Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 Page 23 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. 1. Standard OP26 Regulation 16(2)(k) Requirement The sluice and all other areas of the home must be cleaned and maintained on a regular basis to protect the health, safety and welfare of the people who live there. New staff must not commence work in the home unless a satisfactory Criminal Record Bureau check and Protection of Vulnerable Adults checks have been made. Suitable arrangements must be in place to safeguard people who use the service should a person commence employment before the Criminal Record Bureau check has been returned. Staff involved with the preparation and serving of food and refreshments must follow food hygiene procedures including the use of protective clothing. This will help ensure that people are protected from the risks of cross infection. Timescale for action 14/08/07 2. OP29 19(1)(b) 14/08/07 3. OP38 13(3) 16(j) 14/08/07 Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 Page 24 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 OP12 Good Practice Recommendations It is recommended that the registered person consults people living at the home about their social interests and provides facilities for stimulation and recreation at various times of the day. It is recommended that the registered person review the arrangements in place regarding the designated smoking area. The environmental health department should be contacted for advice to ensure that the home is complying with legislation. 2. OP19 Inglewood Residential Care Home DS0000022693.V341247.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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