CARE HOMES FOR OLDER PEOPLE
Ivy House Nursing Home Hollin Wood Close Moorhead Lane Shipley West Yorkshire BD18 4LG Lead Inspector
Linda Trenouth Unannounced Inspection 14th March 2006 10:00 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 Ivy House Nursing Home DS0000042291.V286135.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. Ivy House Nursing Home DS0000042291.V286135.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Ivy House Nursing Home Address Hollin Wood Close Moorhead Lane Shipley West Yorkshire BD18 4LG 01274 591476 01274 591477 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) Holberry Care Ltd Mr Patrick Berry Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (10), Old age, not falling within any other category (15) Ivy House Nursing Home DS0000042291.V286135.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. See below 1. Residents remaining in the home that fall under the category of older people will be named individually in separate covering letters of registration. As these residents die or move from the home they will be removed from the registration certificate and a new certificate will be issued. This process to continue until none of these service users remain in the home. It has been agreed that no charges will be made when new certificates are issued as part of this process. 31st December 2005 Date of last inspection Brief Description of the Service: Ivy House is a detached Victorian property, which has been converted and extended to provide the care home it is today. The home is registered to provide care, with nursing, for up to forty residents of both genders. The accommodation provides thirty-two single bedrooms and four double rooms. There are a number of communal areas, including lounges, dining area and bathrooms. The home is in a quiet residential area close to the village of Saltaire. The gardens and patio areas are well maintained and are accessible to residents. The main entrance has a ramp and there is ample car parking to the side and front of the home. Ivy House Nursing Home DS0000042291.V286135.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection has to carry out at least two inspections of care homes every year. The inspection year runs from April to March and this was the second inspection visit for 2005/2006. Copies of previous inspection reports are available at the home or on the Internet at www.csci.org.uk. The last inspection of the home was on the 14th December 2005. At that time there were four requirements and three recommendations. Work has been done to address all the requirements and the manager confirmed that all but one had been completed. The three recommendations have also been actioned by the manager. This was an unannounced inspection carried out by one inspector who was at the home from 10.00 until 16.00. The main purpose of this inspection was to make sure that the home continues to provide a good standard of care for the residents. The methods used at this inspection included looking at care records; observing working practices, reviewing the environment and talking to the staff, residents and relatives. Due to their complex needs discussion between the inspectors and residents was limited. During this inspection, the bedrooms and communal areas of the house were viewed. Feedback of the requirements and recommendations were given to the manager at the end of the inspection. Requirements and recommendations made from this visit can be found at the end of the report. What the service does well:
Ivy House has a relaxed and homely atmosphere. The staff interactions with the residents that were observed confirmed that individuals were treat with respect and dignity. Relatives and residents confirmed that staff were patient and caring and that they had a good quality of care at the home. Ivy House Nursing Home DS0000042291.V286135.R01.S.doc Version 5.1 Page 6 It was evident that residents who like to keep active were able to move freely around the communal areas of the home. Others residents were occupied in activities or in discussion with staff or relatives. The management and the staff have a strong relationship with the, ‘Friends of Ivy House’. A representative from the group was visiting the home and expressed her confidence in the management and staff at the home, she felt that the groups work was welcomed and supported. The group met monthly and brought a list of any ideas or concerns they had to the manager and these were effectively dealt with. Other visitors expressed how welcome they were always made to feel and staff made time to talk to them and give them any up to date information they needed. One relative said that the staff contact her by telephone, as she requested, if there were any concerns or changes to her relatives needs. The home has an activity organiser, who provides regular individual and group activities for residents, the care staff also provide daily activities and entertainers are regularly booked. What has improved since the last inspection? What they could do better: Ivy House Nursing Home DS0000042291.V286135.R01.S.doc Version 5.1 Page 7 The drugs storage and records were reviewed. The home ensured a good and safe storage of medication in the home. The general drugs records were satisfactory with the exception of the controlled drugs. A second appropriately trained member of staff must regularly audit this documentation. 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. Ivy House Nursing Home DS0000042291.V286135.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Ivy House Nursing Home DS0000042291.V286135.R01.S.doc Version 5.1 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 the following standard(s): These standards were not reviewed on this inspection visit. EVIDENCE: These standards were not reviewed on this inspection visit. Ivy House Nursing Home DS0000042291.V286135.R01.S.doc Version 5.1 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 the following standard(s): 8 and 9. The health care needs of residents are closely monitored and supported by staff. Medication was stored safely but the administration and auditing of controlled drugs needed to be reviewed to make sure that errors do not occur. EVIDENCE: It was evident in the care plans seen that residents have prompt access to their GP’s, Healthcare staff, Optician and Chiropody. The manager and staff work closely with the Primary Care Trust to ensure that residents have access to a comprehensive full range of health care services. The medication records were reviewed. The general drugs records were satisfactory with the exception of the controlled drugs record. A second appropriately trained member of staff must regularly audit this documentation. Ivy House Nursing Home DS0000042291.V286135.R01.S.doc Version 5.1 Page 11 At present no residents have the capacity to manage their own medication and therefore it the responsibility of the senior staff team to ensure medication is administered as prescribed. One resident does however administer her own eye drops. Ivy House Nursing Home DS0000042291.V286135.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 15. Residents are encouraged to participate in social and leisure activities, to maintain links with their friends and family and to exercise choice and control over their lives. Residents are offered a healthy and interesting diet and appear to enjoy their meals and mealtimes. EVIDENCE: The home employs an activity organiser who works in the home during the week. The activity organiser completes an assessment of residents, which includes their previous hobbies, interests and aspirations. The staff then provide any further recreational opportunities. The activities are adjusted and appropriate to meet the individual skill and understanding of the resident. A relatives group, the ‘Friends of Ivy House’ also encourages activities for the residents by providing support and funding for outings. One relative said these were sometimes special outings for a husbands and wives or a mothers and daughters trips.
Ivy House Nursing Home DS0000042291.V286135.R01.S.doc Version 5.1 Page 13 The cook plans a rotational three-week menu with help from the staff, residents and carers. This shows that there are two choices of main course at lunch and teatime and that a supper is available to those who want it. Specialised liquidised diets are catered for and the food liquidised separately. Diabetic diets are also catered for and celebratory buffets are provided for special events such as birthdays. Where support is necessary staff sit one to one with residents and assist them in their meal. Breakfast was on going throughout the morning encouraging a relaxed routine. The main meal at lunchtime was observed and the residents appeared comfortable and were able to eat at their own pace in a convivial environment. Ivy House Nursing Home DS0000042291.V286135.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The staff have a good understanding of the complaints procedure and adult protection process to ensure that individuals are protected from abuse. Relatives were confident that any concerns or complaints would be taken seriously, investigated and acted upon. The input from the Friends of Ivy House is welcomed and supported by the management of the home. EVIDENCE: The manager has a policy in place which states that the local authority adult protection procedures are to be used. A copy of the revised and updated local authority procedures is available in the office. Staff said that they would have no hesitation in reporting a suspected abusive incident to the person in charge. The areas around the adult protection and whistle blowing are discussed at handovers and staff meetings. Representatives from the Friends of Ivy House were present during the inspection and said they felt able to raise any concerns and felt reassured that these were promptly acted upon. One visiting relative expressed his gratitude and thanks for the help and support he had been given from the staff at the home and how they always included him in the care of his wife, which meant a
Ivy House Nursing Home DS0000042291.V286135.R01.S.doc Version 5.1 Page 15 lot to him. All parties expressed how welcoming and friendly the management and staff are at the home. Ivy House Nursing Home DS0000042291.V286135.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 24, 25 and 26. The home is clean, odour free and provides a comfortable and homely environment for residents. EVIDENCE: Ivy House Nursing Home DS0000042291.V286135.R01.S.doc Version 5.1 Page 17 The home is situated in a quiet residential area on the outskirts of Bradford. The building is well maintained. The gardens are landscaped and have been fenced so that residents can access them safely. The home employs full time maintenance staff and a record of all repairs carried out is maintained. Both care and ancillary staff raise any maintenance concerns within the communal areas and bedrooms. All bedroom doors are lockable one resident locks her bedroom door and manages the key independently. The sluice door has been fitted with a coded lock to ensure the door remains locked when not in use. New wheelchairs have been purchased to meet the needs of the less mobile residents safely. The bedrooms are furnished comfortably and residents and their families may add additional furniture, pictures and personal memorabilia. It was recommended that the use of signage or posters on the residents bedrooms walls to instruct the staff is reviewed to protect the dignity of the individual and the bedroom environment. New flooring, both carpet and laminated wood effect has been provided in residents bedrooms where required. The bedrooms are decorated in accordance with the wishes of the resident and their families. Ivy House Nursing Home DS0000042291.V286135.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29. Staff are consistently well supported by the management of the home to help them care for the residents safely and effectively. EVIDENCE: The manager and key staff confirmed that they have regular supervision meetings. These sessions are formulised and recorded. Staff meetings are organised for the nurses and the carers at the home. The full team meetings are organised in such away as to have the maximum attendance from staff. Handovers occur between each shift and additional areas of care are discussed at these sessions. Ivy House Nursing Home DS0000042291.V286135.R01.S.doc Version 5.1 Page 19 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): 32, 37 and 38. The home is well managed and health and safety is seen has very important to the manager and staff of the home. The relatives said that they were included in the decision-making and their views and opinions were sought. The management and staff at the home create an environment of openness and respect. EVIDENCE: During discussions with relatives and staff it was felt that the manager is approachable and very supportive to staff. Relatives visiting the home during the inspection were very complimentary about the care their relative received. They felt that the Ivy House was a good care home and the management and staff were responsive to their requests
Ivy House Nursing Home DS0000042291.V286135.R01.S.doc Version 5.1 Page 20 and queries. They felt well informed of changes to their relatives needs and were always made to feel welcome at the home. A support group has been formed, the ‘Friends of Ivy House’, which meets every month. Relatives run the group and they will discuss meals, daily activities, trips, outings and fundraising events to provide more outings. The manager attends the meetings of the group by invitation. The spokesperson for the group meets regularly with the manager and staff at the home. The group have recently purchased a projection TV for the residents, which is especially good for showing films as it greatly enlarges the viewing, area. The home has a policies and procedures file, which is kept in the office and accessible to all staff. The inspector sampled a number of these policies and procedures and found that they were relevant and provided support and guidance to the staff at the home. The care plans are regularly updated along with the risk assessments, tissue viability and nutritional screening. Staff showed a good awareness and attitude to health and safety in the home. The catering staff are vigilant and check food storage and temperatures regularly. Because of this vigilance a food delivery to the home was rejected because the temperatures in the delivery vehicle was unsafe to hold food. Records were available to confirm that electrical testing was undertaken and that fire safety systems were checked. Ivy House Nursing Home DS0000042291.V286135.R01.S.doc Version 5.1 Page 21 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x x 3 3 3 3 STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 x x x x 3 3 Ivy House Nursing Home DS0000042291.V286135.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes. 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 OP9 Regulation 13 Requirement The controlled drugs records must be completed correctly and a suitably qualified individual must undertake a regular audit of the drugs records. The registered person must make sure security equipment is working effectively so that resident safety is not compromised. The manager is awaiting the contractor to complete this. (Previous timescale 30/03/06.) Timescale for action 18/05/06 2. OP19 13 and 16 18/05/06 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. 2. Refer to Standard OP14 OP10 Good Practice Recommendations The recommendation to provide visual prompts and signage is still valid. The manager should review the use of signage placed in residents bedrooms, which are instructions to staff about
DS0000042291.V286135.R01.S.doc Version 5.1 Page 23 Ivy House Nursing Home laundry and appropriate bedding. Ivy House Nursing Home DS0000042291.V286135.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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