Inspection on 27/02/06 for Inwood House

This inspection was carried out on 27th 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

Inwood House 20/03/08

Inwood House 15/01/07

Inwood House 13/09/05

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Inwood House Inwood House 10 Bellamy Lane Salisbury Wilts SP1 2SP Lead Inspector Ms Sally Walker Unannounced Inspection 09:30 27 February 2006 th 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 Inwood House DS0000063485.V278726.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. 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. Inwood House DS0000063485.V278726.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Inwood House Address Inwood House 10 Bellamy Lane Salisbury Wilts SP1 2SP 01722 331980 01722 331985 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) Mr Alan Butchers Mrs Diana Butchers Mr Alan Butchers Care Home 20 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (10), Old age, not falling within any other category (20) Inwood House DS0000063485.V278726.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. No more than 20 service users with old age, over 65 years of age at anyone time. No more than 10 service users with a mental disorder, over 65 years of age at anyone time No more than 1 male service user with a mental disorder at anyone time 13th September 2005 Date of last inspection Brief Description of the Service: Mr Butchers was registered to Inwood House on 1st April 2005. The home is an established care home in Salisbury near the city centre. It is registered to provide personal care to up to 20 older people 10 of whom may also have additional mental health needs; one of whom is under the age of 65. Accommodation is to three floors accessed by a passenger lift and stairs. All but one of the single bedrooms has en-suite toilet facilities. There are 2 bathrooms and one shower room with toilets to the ground floor near the sitting room and dining room. The staffing rota provides for a minimum of 4 care staff during the mornings, three during the afternoon and evening, with one waking night staff and one member of staff sleeping in. This is one of 2 homes run by Mr and Mrs Butchers. Inwood House DS0000063485.V278726.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9.30am and 5.00pm. Mrs Butcher was present during the inspection and Mr Butchers arrived after completing some other work. A tour of the building was made. Five residents, 2 staff and the visiting chiropodist were spoken with. The care records, risk assessments, staff records and fire logbook were inspected. What the service does well: What has improved since the last inspection? What they could do better: As the home is registered for 11 people with mental health problems there should be an ongoing programme of regular training in this subject to ensure staff have a better understanding of their work. The undersides of toilet surrounds and bath hoist seats should be added to the cleaning schedules to ensure there is no build up of lime scale. Rusty commodes must be replaced, as they are very difficult to keep cleaned to infection control standards. Mrs Butchers had already identified that not all of the information and copies of documents required as evidence of robust recruitment had been retained on Inwood House DS0000063485.V278726.R01.S.doc Version 5.1 Page 6 file. Mrs Butchers and her PA were in the process of auditing these records and had identified some anomalies. Care plans need to identify guidance to staff on the administration of medication that is only taken when needed. Fire risk assessments need amendment if events occur and all staff need to sign the log to show that they have received regular instruction. 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. Inwood House DS0000063485.V278726.R01.S.doc Version 5.1 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 Inwood House DS0000063485.V278726.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The home carries out full and detailed assessments of any potential residents to make sure that the home can meet their needs. EVIDENCE: Pre-admission assessments had been carried out with each of the residents admitted to the home since Mr Butchers took over the running of the home. Information was gained from a variety of sources including, the resident, family and carers, any previous placement, care management assessments and the home’s own detailed assessment. Inwood House DS0000063485.V278726.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Care plans detailed all aspects of residents social, medical and physical care needs and were regularly reviewed. Residents had good access to healthcare professionals. The systems for the safe administration and control of medication was being properly managed. Staff valued residents privacy and treated them with respect. EVIDENCE: The care plans were very detailed and showed all aspects of residents care and support needs. The care plans identified residents’ social and communication needs as well as physical or personal care needs. The plans showed good evidence of how staff were monitoring progress with monthly and 6 monthly reviews. Amendments were made to the plans when needs changed. Information gathered form the previous providers’ notes about residents had been transferred to the pre-admission document used in both homes in order to develop new care plans for each of the existing residents. At the front of each care plan was a resume of each residents preferred routines throughout the day and night. Particular attention was paid to ensuring an obstruction free environment for residents who may have a visual impairment and to make sure they were aware of events. The care manager had started to collate information from residents about their life histories and was writing to Inwood House DS0000063485.V278726.R01.S.doc Version 5.1 Page 10 residents’ families to ask for other details of family history which may be relevant. The daily reports showed that the care plans directed the care. Risk assessments were in place, regularly reviewed and staff were required to sign to show that they understood the guidance. Assessment were in place for moving and handling, risk of developing pressure sores, depression and going out alone. Residents were weighed on admission and monthly thereafter. Any significant loss was reported to the GP. Homes in this area have had some difficulty in obtaining tissue viability training, as there is no specialist nurse. The new training pack being implemented had a section on preventing pressure sores. Pressure relieving equipment was in place where necessary and it was clear from the records that any concerns would be referred to the district nurse. Body maps were being used for recording any marks or wounds. Those residents who were prescribed pressure relieving equipment had mattresses in their bedrooms and cushions in chairs either in the dining room or sitting room. Mr Butchers reported on great success with medication that some residents had been prescribed for many years. The GP had reviewed all the medication and following a programme of reduction there was noticeable improvements to the residents’ quality of life, mental health and abilities. Many of the residents said they managed their own medication which was kept in a locked facility in their rooms. They said the staff always had replacement stocks. The medication administration record were being satisfactorily completed with all received medication checked and regular stock audits. The care plans showed that the medication was being regularly reviewed with the prescribers and reasons for specific medications to be given, for example, pain killers and other medication to be taken when required. ‘Seek advice’ was written against medication for one resident but the care plan did not identify reasons for giving this medication. Staff were able to verbally describe triggers for its administration but this needs to be in the care plan. Records were kept of all healthcare professionals visits and advice. Residents said their GPs visited them at the home and that staff would always make appointments. Staff were seen to be friendly and engaged with residents. All personal care was provided behind closed doors. The visiting chiropodist said that they found the staff to be very caring and their foot care was good. Residents had good access to other healthcare professionals including a physiotherapist who was visiting that day. Inwood House DS0000063485.V278726.R01.S.doc Version 5.1 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 the following standard(s): 12, 13 & 14 Residents were able to following their own routines and spend their day as they wished. Residents had opportunities to access a range of activities both at the home and in the locality. Residents were encouraged to retain as much control over their lives as possible. EVIDENCE: Residents could spend their day as they wished in their bedrooms, in 2 sitting rooms or the conservatory. One resident said they enjoyed having their breakfast in their room so they could get up in their own room. One residents who was asking if lunch was ready and could they have a sandwich during the midmorning was given a sandwich and a hot drink. One resident said that they enjoyed the activities in the home and that they would be taken out by Mr Butchers to 3 local supermarkets or for a drive around the locality and have a coffee somewhere. The home had its own transport. One resident said they regularly got a taxi into Salisbury to do their own shopping. They said there were musical events with entertainers, crosswords, scrabble or bingo. Activities were noted in residents social care plans and separate records were kept of each daily activity. The daily shift plan identified which member of staff was involved in activities. Inwood House DS0000063485.V278726.R01.S.doc Version 5.1 Page 12 All of those residents spoken with said they enjoyed the range and quality of the food provided. Some described their favourite meals. Residents were offered a sherry before lunch. Inwood House DS0000063485.V278726.R01.S.doc Version 5.1 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 the following standard(s): 16 & 18 Residents said they could talk to staff or Mr Butchers about anything they were not satisfied with. Systems were in place for reporting any allegations of abuse. EVIDENCE: The home had a complaints procedure and form for complainants to set out their issues. The records showed details of each complaint, records of investigation and action taken. Residents were asked about making complaints or talking about issues they were not happy with. They said they would talk to the care manager or Mr Butchers. The home works to the local policy and procedure on the protection of vulnerable adults. The new training pack being implemented had a section on abuse and vulnerable adults and staff were made aware of the policy on induction. Inwood House DS0000063485.V278726.R01.S.doc Version 5.1 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 the following standard(s): 19 & 26 Residents live in a well maintained, clean and comfortable environment. Some undersides of bath hoists had build up of lime scale and one toilet surround needed replacing. EVIDENCE: The home was well maintained. All bedrooms were single accommodation and all but one had its own ensuite toilet and wash hand basin. Bedrooms were individually decorated and furnished to suit the personality of the residents. One resident show the furniture they had brought from their own home. One resident described the new shower which had recently been installed. They said they showered alone whenever they wanted to. Mrs Butchers discussed her plans for improvements to the building. She said she had come to the home that day to carry out an audit on the environment as well as the monthly environmental check. She planned to put another bathroom on the ground floor and use the top bathroom as a hairdressing room. There were plans to move the toilet off one of the sitting rooms, to extend the available space and relocate the toilet elsewhere. The area used to keep records would be located in a proper staff room. Inwood House DS0000063485.V278726.R01.S.doc Version 5.1 Page 15 All of those residents who were spending the morning in their bedrooms had their call bells within easy access. There were hoists and moving aids available to staff. The home was generally cleaned to a visibly high standard and no unpleasant odours were detected at any time during the inspection. However, one toilet surround with seat was heavily rusted, the undersides of 2 bath hoists had a build up of lime scale and one raised toilet seat had not been cleaned underneath for some time. The Health Protection Agency guidance on infection control in care homes was sent to the home. Inwood House DS0000063485.V278726.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 30 Residents benefit from sufficient numbers of trained, supervised and supportive staff. Core training, whilst extensive, lacks a programme of regular training in mental healthcare. Without relevant documents the home could not prove their robust recruitment procedure. EVIDENCE: There were 2 carers and the care manager working with the cook and a domestic. At night there were one waking and one member of staff sleeping in. Mrs Butchers showed the new training pack she had purchased with modules for related subjects. There were workbooks which would be externally marked. Mrs Butchers is the trained trainer for moving and handling and first aid for both homes and staff received regular updated training. Staff had received training in palliative care the previous week. The care manager said she was undertaking the Registered Managers Award and NVQ Level 4. The care manager said that she was undertaking a three month course in Dementia which she found particularly interesting. Staff reported difficulties following the closure of their training provider for NVQs and another provider was being sought so that all their work could be assessed for the completion of the award. The home is registered for 11 places for people with mental health problems but there was no programme of continued training in this area. Mr Butchers said the community psychiatric nurse visited regularly and gave advice. Discussions were held with Mr Butchers with regard to what form this training should take. He was advised to request some training from the Inwood House DS0000063485.V278726.R01.S.doc Version 5.1 Page 17 visiting community psychiatric nurse and other contacts at the hospital or other agencies specialising in mental health. The home could support this with a library of resource material from publications or the Internet. Mr Butchers said that Mrs Butchers and her PA were auditing the staffing records having found some anomalies, to ensure that all the required information and documents were in place. Mrs Butchers showed the inspector where the anomalies had occurred between the original check list of documents and what was on file. All of those residents spoken with said that the staff were very friendly and had time for a chat. Staff were seen to give consideration to residents confidentiality when discussing issues with residents in a public space. Staff said they had regular supervision. Inwood House DS0000063485.V278726.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 & 38 Recording systems used in Mr and Mrs Butchers other home were gradually being implemented. Risk assessments were in place for individual residents. Improvements had been made to the reporting of fire prevention checks. EVIDENCE: Mrs Butchers said she was gradually getting all the records in place having implemented the same system as the other home. The administrator was making sure the business records were up to date. The requirement that regular tests, checks and instruction to staff were carried out and recorded in the fire log book in line with the requirements of the Fire Authority had been actioned in part. Not all of the staff receiving instruction had signed the log to denote this. The inspector advised that the names of staff who had attended each drill should be included in the records to show that all had had experience of a drill at least once throughout the year. The inspector also advised that the fire risk assessment should have been reviewed and revised if necessarily following a recent incident. Inwood House DS0000063485.V278726.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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X 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 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X 3 3 Inwood House DS0000063485.V278726.R01.S.doc Version 5.1 Page 20 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 OP7 Regulation 13(2) Requirement The person registered must ensure that guidance is written in residents care plans for all medication to taken only when required. The registered person must ensure that the undersides of toilet surrounds and bath hoist seats are included in the cleaning schedule to make sure there is no build up of lime scale. All rusted toilet surrounds, which cannot be cleaned to infection control standards must be replaced. The person registered must ensure that a programme of regular training is in place for working with people with mental health problems. The person registered must ensure that all the information and copies of documents required by Schedule 2 are retained on file. The registered person must ensure that the necessary review and revision of the fire risk assessment is carried out when DS0000063485.V278726.R01.S.doc Timescale for action 27/02/06 2 OP26 23(2)(d) 27/02/06 3 OP30 18(1) (c)(i) 30/04/06 4 OP29 19(1)(b)& (c) 27/02/06 5 OP38 13(4)(c) 27/02/06 Inwood House Version 5.1 Page 21 6 OP38 17(2), Sch 4 para 14 event occur. The registered person must ensure that staff sign the fire log book to show that they have received regular fire safety instruction. 27/02/06 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 OP38 Good Practice Recommendations The names of staff attending a fire drill should be recorded in the log. 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