CARE HOMES FOR OLDER PEOPLE
Ivydene Care Home Ivydene Close Earl Shilton Leicestershire LE9 7NR Lead Inspector
Chris Wroe Unannounced 31 August 2005 at 10.00am 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. Ivydene Care Home C51 C01 S32007 Ivydene Care Home V245099 230805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Ivydene Care Home Address Ivydene Close Earl Shilton Leicestershire LE9 7NR 01455 843991 01455 843001 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) Ivydene Care Home Ltd Mrs Susan Beardmore Care Home 23 Category(ies) of DE(E) Dementia over 65 - 23 registration, with number MD(E) Mental Disability over 65 - 23 of places Ivydene Care Home C51 C01 S32007 Ivydene Care Home V245099 230805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd February 2005 Brief Description of the Service: Ivydene is registered to provide care for twenty-three older people with dementia and/or mental disorder. The home is situated in a quiet and secluded cul-de-sac, close to the centre of Earl Shilton. A range of facilities are located nearby. Residents bedrooms are situated on the ground and first floors. Access to the first floor is available via a passenger lift, although some of the bedrooms are only accessible via the stairs. There are eleven single and six double bedrooms. In addition to their rooms, resdients have access to two lounges, a dining room and a large garden. Ivydene Care Home C51 C01 S32007 Ivydene Care Home V245099 230805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place on a weekday, 31st August 2005, starting at 10.00am and lasting for five hours. The deputy manager and senior care staff helped the inspector to find all information needed. Residents were at home during the inspection, and the inspector spoke with a number of them about how they liked living in the home. The main method of inspection used was ‘case tracking’, which involved selecting four residents and tracking the care they receive through checking records, talking with the residents and with care staff, looking round the home and observing care practices. Comments and views were given by six residents with whom the inspector talked. These included the following: ‘It’s not like being at home, but I’m very happy with the place and with the care – it’s very pleasant’. ‘I can’t fault it. The food is good. The staff look after me well’. One relative also gave views during the inspection, saying that he was very pleased with the care of his relatives, and that the attitude of staff towards residents was very caring. The information below relates to the standards checked and observed during the inspection: What the service does well:
The admissions process in effective, with full assessments carried out before someone moves into the home. There are good care plans in place, including social histories of residents, which give information about what has been important to them in their lives. Staff keep good daily records, which show an awareness of residents’ wellbeing and health needs. Visitors are welcomed into the home and encouraged to have contact with residents. Residents can bring personal possessions into the home.
Ivydene Care Home C51 C01 S32007 Ivydene Care Home V245099 230805 Stage 4.doc Version 1.40 Page 6 There is a supportive staff group in the home, who help each other in their work, and create a good atmosphere for residents. There are good policies and procedures in place in the home. What has improved since the last inspection? What they could do better:
Formal risk assessments should be carried out, so that staff can help residents to be safe in their daily lives, for example to help prevent falls. Further attention could be given to residents’ nailcare (cutting nails). Staff must ensure that only medication prescribed for a resident is given to them. Risk assessments should be carried individually out for residents to assess the safety of keeping denture cleansing tablets in their bedrooms, and safety measures put in place where a need is identified. Attention could be given to providing a greater range of activities for residents, including, where possible, outside the home. Training should be given to care staff to ensure that they are fully aware of procedures, which must be followed where any harm to a resident is suspected. The fire service must be consulted to request advice regarding the safety of fire escapes identified as being blocked (immediate requirement made at inspection).
Ivydene Care Home C51 C01 S32007 Ivydene Care Home V245099 230805 Stage 4.doc Version 1.40 Page 7 Residents who share bedrooms could be offered the opportunity to have their own bedroom where space becomes available, particularly where they may be affected by the personal needs of another resident. An assessment of the risks to residents of uncovered radiators and other heaters must be carried out and safety measures put in place where a need is identified. 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. Ivydene Care Home C51 C01 S32007 Ivydene Care Home V245099 230805 Stage 4.doc Version 1.40 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 Ivydene Care Home C51 C01 S32007 Ivydene Care Home V245099 230805 Stage 4.doc Version 1.40 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) 2, 3 Residents’ move into the home is well managed. EVIDENCE: Assessments are carried out for new residents, and information is gathered from social services and health assessments, to make sure staff can provide what the resident needs. Contract and terms and conditions are in place for residents. There are policies in place, which describe the process of admission into the home, and information is given to people who want to come into the home. Ivydene Care Home C51 C01 S32007 Ivydene Care Home V245099 230805 Stage 4.doc Version 1.40 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, 8, 9, 11 Residents’ health, personal and social care needs are mostly well met. EVIDENCE: There are care plans in place for residents, which detail what their care needs are. These include a personal history of the resident, which gives good information about who they are, and what has been important to them in their life. Staff show a good understanding of the needs of residents. Daily records show that good attention is paid to residents’ health care needs. Risk assessments were not in place, to detail how staff will help residents to do things safely (for example, prevent falls). Residents were mainly well cared for, although nails were observed to be in need of cutting. Some improvements in the above areas are recommended. Medication administration was mainly well managed. Two pots of medicating cream were found in one resident’s bedroom, which belonged to other residents no longer in the home – the creams were removed by staff. Denture cleansing tablets, which can pose a risk to residents with dementia, were found
Ivydene Care Home C51 C01 S32007 Ivydene Care Home V245099 230805 Stage 4.doc Version 1.40 Page 11 to be kept in bedrooms, and staff should assess the risks to residents of their storage. The recent death of a resident had been sensitively handled by staff. One relative described that staff were very supportive in helping with care of very ill residents. Ivydene Care Home C51 C01 S32007 Ivydene Care Home V245099 230805 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 15 Residents are mainly enabled to have a good standard of daily living. EVIDENCE: Activities’ records show that some activities take place occasionally in the home, such as singing, nail care, reading. Residents had recently sat outside for the local carnival, but there are not many other opportunities for residents to go out if they do not have relatives to take them. Visitors are encouraged and welcomed. One relative said that staff communicate well with relatives, keep them informed and tell them about any concerns. Residents said that the meals provided in the home are good. The cook showed understanding of the differing dietary needs of residents. Choices are offered to residents. Ivydene Care Home C51 C01 S32007 Ivydene Care Home V245099 230805 Stage 4.doc Version 1.40 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 standard(s) 16, 18 Residents are mainly protected by procedures in the home to safeguard their welfare. EVIDENCE: There is a complaints procedure in place in the home, and residents and one relative said that they could raise any concerns they had with staff. There are policies in place relating to protecting vulnerable people in the home from abuse, and action that should be taken where there is any suspicion of abuse. Staff were aware that they should tell their manager about any concerns, but they were not aware of the procedure or what action should be taken to protect residents. This area should be improved. Ivydene Care Home C51 C01 S32007 Ivydene Care Home V245099 230805 Stage 4.doc Version 1.40 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 standard(s) 19, 23, 24, 25 Residents are mainly safe and comfortable in their environment. EVIDENCE: Residents are able to bring personal possessions for their bedrooms. Bedrooms are appropriately furnished, and some have recently had new wardrobes and drawers. There are a number of shared bedrooms in the home, although there are some empty rooms at the moment. An assessment has not recently been done to see if any residents would prefer not to share – this would be recommended in light of some of the personal needs of residents. An uncovered electric heater was found to be at low level in one resident’s bedroom, causing a potential risk. This aspect of risk has been noted in previous inspections, and attention is needed to ensure the risk is removed. Residents enjoy sitting in the rear courtyard of the home in good weather. One fire escape in this area was found to be locked with a chain and
Ivydene Care Home C51 C01 S32007 Ivydene Care Home V245099 230805 Stage 4.doc Version 1.40 Page 15 combination padlock, creating a potential safety risk. One exit was blocked by the position of a bench, and a fire exit door was found to be bolted shut with a high level bolt. Immediate attention to these matters was required. Ivydene Care Home C51 C01 S32007 Ivydene Care Home V245099 230805 Stage 4.doc Version 1.40 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 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) 27, 29, 30 Residents are protected by staffing arrangements in the home. EVIDENCE: Staff rotas show that minimum staffing levels are met. There were sufficient numbers of staff on duty during the inspection. Proper recruitment procedures are in place in the home, including collection of applications and references regarding new applicants. Staff confirmed that they received ongoing training, including induction training for new staff, to tell them how to provide good care for residents. Staff were supportive to each other in their work. Ivydene Care Home C51 C01 S32007 Ivydene Care Home V245099 230805 Stage 4.doc Version 1.40 Page 17 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) 38 The health and safety of residents is protected by procedures in the home. EVIDENCE: Checks are done to ensure that safety is maintained in the home, including fire safety tests, and food checks. Policies are in place to inform staff about safe working practices. Good infection control measures are in place, and the deputy manager ensured procedures were carried out properly. Ivydene Care Home C51 C01 S32007 Ivydene Care Home V245099 230805 Stage 4.doc Version 1.40 Page 18 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 x 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 x x x 3 3 2 x STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x x x x 3 Ivydene Care Home C51 C01 S32007 Ivydene Care Home V245099 230805 Stage 4.doc Version 1.40 Page 19 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. Standard 9 Regulation 13 Requirement Staff must ensure that only medication prescribed for a resident is given to them. Timescale for action Forthwith. Inform Commission of action taken by 30th September 2005. Immediate - by 1st September 2005. Inform Commission of action taken by 30th september 2005. Inform Commission of action taken by 30th September 2005. 2. 19 23 The fire service must be consulted to request advice regarding the safety of fire escapes identified as being blocked. 3. 25 23 Risk assessments must be carried out relating to the risk to residents of uncovered radiators and other heaters, and safety measures put in place where a need is identified. Ivydene Care Home C51 C01 S32007 Ivydene Care Home V245099 230805 Stage 4.doc Version 1.40 Page 20 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. 3. Refer to Standard 8 8 9 Good Practice Recommendations It is strongly recommended that formal risk assessments are carried out so that staff can help residents to be safe in their daily lives, for example to help prevent falls. It is recommended that further attention is paid to cutting residents nails. It is strongly recommended that risk assessments be carried out individually for residents to assess the safety of keeping denture cleansing tablets in their bedrooms, and that safety measures are put in place where a risk is identified. It is strongly recommended that training be given to care staff to ensure that they are fully aware of procedures which must be followed where any harm to a resident is suspected. It is recommended that residents who share a bedroom are given the opportunity to choose to have their own bedroom where space becomes available, particularly where they may be affected by the personal needs of another resident. 4. 12 5. 23 Ivydene Care Home C51 C01 S32007 Ivydene Care Home V245099 230805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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