CARE HOMES FOR OLDER PEOPLE
Ivydene Care Home Staniforth Drive Ivybridge Plymouth Devon PL21 0UJ Lead Inspector
Fiona Cartlidge Unannounced Inspection 12th December 2006 11:00 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 Ivydene Care Home DS0000061638.V324107.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. Ivydene Care Home DS0000061638.V324107.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Ivydene Care Home Address Staniforth Drive Ivybridge Plymouth Devon PL21 0UJ 01752 894888 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) Sanctuary Care Limited Vacancy Care Home 57 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability over 65 years of age of places (57) Ivydene Care Home DS0000061638.V324107.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Physical Disability over 65 years of age (PD(e)) 37 Both Terminally Ill over 65 years of age (TI(e)) 5 Both Old age not falling within any other category (OP) 20 Both One Service User under the age of 65 years (named elsewhere) Date of last inspection 24th May 2006 Brief Description of the Service: Ivydene is a purpose built care home, situated in the town of Ivybridge, providing nursing and/or personal care for up to 57 persons over the age of 65 years of age of either gender. The home is designed to care for persons suffering with varying degrees pf physical disability/frailty or illness. The accommodation is located on 2 floors with 2 passenger lifts providing access to the 1st floor. All the bedrooms have the benefit of en-suite WC and wash hand basin. 7 bedrooms are dedicated to persons receiving short term nursing care funded by the NHS. Ivydene has large communal areas including dining room and large lounge and 2 smaller lounges. There is a pleasant patio area with flower- beds; the town centre is a short distance away. Ivydene was first registered in 1994. Information about the home was found in the entrance hall and this asks readers to request a copy of the latest inspection reports from the administration office. Information given to the Commission by the provider indicates the current range of fees is from £287 to £569/week. Ivydene Care Home DS0000061638.V324107.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The main site visit took place over 6 hours and was unannounced. A partial tour of the home took place when some bedrooms and all communal areas were viewed. Four residents had their care case tracked this means their records were examined in detail and three of the four residents were spoken to in depth about the care and services they receive. The fourth resident being case tracked was spoken to briefly and their care was observed. Ten other residents were spoken with during the visit, as were 3 visitors/relatives one health care professional and 3 members of staff and the registered manager. Personnel records of 3 members of staff and policies and procedures were also inspected. What the service does well: What has improved since the last inspection?
Ivydene Care Home DS0000061638.V324107.R01.S.doc Version 5.2 Page 6 The choice of menus is better communicated to residents. At the time of this inspection, feedback about the meals served in the home was mostly positive. The menu on display on notice boards advertises a choice of menu at each mealtime and food being prepared for the teatime meal included a selection of sandwiches or cheese on toast and cake and a selection of desserts were seen to be available. Recent surveys about the food in the home have been collated and information from these and from residents meetings has been used to influence the menu within the home. What they could do better: 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. Ivydene Care Home DS0000061638.V324107.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 Ivydene Care Home DS0000061638.V324107.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admissions process is safe. EVIDENCE: An assessment of care needs of prospective service users takes place prior to admission to the home. Records seen included copies of assessments carried out by the homes manager as well as through care management arrangements and hospital/community health care teams where applicable. An assessment of need is performed by staff following the residents’ admission and this information and that from the preadmission care management/health assessments informs the homes care planning process. Ivydene Care Home DS0000061638.V324107.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs are set out in an individual plan of care but these do not always provide enough detail to ensure that the staff are able to consistently meet all of the needs of some residents. The registered person promotes and maintains residents’ health and ensures access to health care services to meet assessed needs. The homes medication system protects the medical welfare of residents. Residents are treated with respect and their right to privacy is upheld. EVIDENCE: Personal records held on behalf of 5 residents were examined; in all of those seen there were documented assessments which provided information about skin integrity, moving and handling, safety - including risk of falls and nutritional screening. The information generates the plans of care, which provide the basis for the care to be delivered. Two of the care plans did not contain sufficient information to ensure that staff following the plan could
Ivydene Care Home DS0000061638.V324107.R01.S.doc Version 5.2 Page 10 provide consistent care to the individuals and 2 had not been regularly reviewed by staff with input from the residents and/or their representatives. Records are maintained for all visits to the home by social or health care professionals, all residents are registered with a GP. Records provided evidence that as well as visits from General Practitioners, district and specialist nurses, chiropodists, physiotherapists and dentist’s visit. Records of outpatient appointments show that visits to community and hospital health resources are enabled. The medication system is well managed; the inspector looked at storage and recording – controlled drug stock was checked against records and found to be correct The home uses a monitored dosage system, which is well organised and easily audited and administered from purpose built trolleys directly to the residents on a 1:1 basis. Disposal of unused medication is safe, well recorded and removed by a licensed contractor. Staff were seen and heard knocking on doors before entering rooms and were carrying out personal tasks in private. Staff observed in 1:1 conversation with residents were heard to be courteous and respectful. Residents spoken with confirmed the staff treat them with dignity and respect their privacy. Ivydene Care Home DS0000061638.V324107.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Considerable effort is made by the home to provide an activities programme and social interaction/stimulation for residents. Residents are able to maintain contact with family and friends and exercise choice and control over their lives. Residents receive a wholesome appealing diet a choice of meals is available. EVIDENCE: This home employs a person dedicated to organising and providing social activities to meet the needs of those living in the home. During this visit the inspector saw that some residents were socialising in the lounges or watching television others were spending time in their rooms, reading, listening to music or watching television. In the afternoon a group of people from a local church sang carols in the lounges. A monthly news - letter is distributed to residents to provide information about the group social activities available, those in December included sessions titled - poets corner, remember that, handicrafts and knitting circle, bingo,
Ivydene Care Home DS0000061638.V324107.R01.S.doc Version 5.2 Page 12 bookworm club, Ivydene Olympics, Board games, recreational movement to music, count down quiz, coffee morning, a film slide of ‘Plymouth at Christmas time’, exercise classes, sing a longs and a Christmas pantomime. Residents were aware of the group activities advertised in the monthly diary and confirmed they can pick and chose which ones to attend. Feedback about the meals served in the home was mostly positive. The menu on display on notice boards advertises a choice of menu at each mealtime and food being prepared for the teatime meal included a selection of sandwiches or cheese on toast and cake and a selection of desserts were seen to be available. Recent surveys about the food in the home have been collated and information from these and from residents meetings has been used to influence the menu within the home. The people living in the home told the inspector they were happy with the visiting arrangements, visitors said they feel welcomed into the home and are able to visit their relative/friend in private or socially. Ivydene Care Home DS0000061638.V324107.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives/friends know how to make a complaint. are safe living in this home. EVIDENCE: People The complaints procedure was found to be included in the document ‘service users guide’ which was situated in the entrance hall. Three people who had their care case tracked said they were aware of how to make a complaint but all confirmed they had nothing to complain about. Residents said they feel safe living in the home. A record of complaints is maintained and was examined. There has been one complaint referred to the Commission about this service. The manager had responded to the complainant and there was evidence that some action had been taken as a result.. The policies and procedures seen, included information on adult protection including an appendix providing information about local agencies contact numbers and whistle blowing.
Ivydene Care Home DS0000061638.V324107.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is safe and adequately maintained. The home is clean and hygienic. EVIDENCE: A tour of the home provided evidence that the providers maintain an attractively presented environment for residents and staff that is well maintained. Maintenance and associated records seen indicated that Fire equipment, Moving and handling equipment (including passenger lifts) and gas and electrical installations are checked and serviced regularly. Resident’s rooms contained personal items of furniture and ornaments and pictures. All of those spoken to said they liked their rooms, some particularly commented positively about the fact they have there own en suite WC.
Ivydene Care Home DS0000061638.V324107.R01.S.doc Version 5.2 Page 15 The home appeared well equipped to meet the needs of those residents identified with moving and handling risks and disabilities that affect their capability to bathe. The gardens are safe and accessible and were attractive for the time of year. A redecoration and refurbishment programme is in place and the home employs an ‘in house’ maintenance person. Pressure relieving mattresses were seen in place for those residents requiring them, as were height adjustable beds. The communal areas of the home were fresh and clean in their appearance; Hand washing facilities are available throughout the home as were protective gloves. Ivydene Care Home DS0000061638.V324107.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are not always sufficient numbers of staff to meet the needs of residents in this home. The staff team collectively have the appropriate skills and knowledge to care for those people resident in the home. The homes recruitment practise protects residents from being placed at risk of harm or abuse. EVIDENCE: Personnel records were seen for 3 members of staff who had recently been employed; the records contained evidence that all required checks had been performed to ensure the prospective staff are suitable to work within a registered care setting. In addition other evidence of good practise included record of recruitment interviews. Records and notices provided evidence of on going training and a commitment to National Vocational Training. Information on the homes training matrix shows that more than 50 of the staff have obtained a national Vocational Qualification at level 2 or above. 5 residents were spoken with in detail, their feedback described staff as hard working, kind and respectful.
Ivydene Care Home DS0000061638.V324107.R01.S.doc Version 5.2 Page 17 A complaint received by the Commission indicated that at times call bells are not answered in a timely fashion and therefore residents needs are not met, this complaint was investigated by the provider and the Commission and both found evidence supporting the complainants statement about the slow response times. At the time of the site visit there were occasions when call bells were ringing for approximately 10 minutes without response. One resident said that although they would like a bath more than once a week they could not because there is not enough staff. On the day of the visit staff confirmed they were short handed because someone had not been able to work and they could not be replaced because of the short notice given. The complaints record held within the home also contained concern about the length of time it took for staff to answer call bells, this had been investigated and it was agreed that some response times were too long a written response was sent to the complainant apologising and confirming the manager would address the issue with staff and review break time allocations. Despite this response times for some remain unacceptable and a requirement has been made in this report for the provider to review staffing levels and ensure sufficient staff are available to meet the needs of residents at all times. Ivydene Care Home DS0000061638.V324107.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management arrangements are meeting the needs of the service, and the quality of the service is continually assessed. The registered provider shows a responsible attitude toward promoting and protecting the health, safety and welfare of residents and staff. EVIDENCE: Comments received from residents and staff during the field trip confirmed that the new manager is well respected and meaningful interaction by the manager with staff and residents was witnessed. The inspector examined the records and storage of personal money held in the home on behalf of residents. A random selection of actual balances were
Ivydene Care Home DS0000061638.V324107.R01.S.doc Version 5.2 Page 19 checked against the documentation and found to be correct. Best practise systems are in place for the protection of both residents and staff. The minutes of staff and resident meetings and catering surveys, supports the management approach of involving residents and staff in continual improvement to the service. Internal auditing processes are in place, an external company manager visits the home on a monthly basis and performs a systems audit as well as feedback from residents and staff the results of which are reported to the manager to ensure a plan is made to address any short falls. The Commission receives a copy of this report. The provider demonstrates a responsible attitude towards health and safety. Many fire doors that were open were being held by ‘safe’ hold open devices and notices were displayed throughout the home. Risks to residents are individually assessed and documented with an agreed plan in place to minimise risk where possible. Ivydene Care Home DS0000061638.V324107.R01.S.doc Version 5.2 Page 20 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 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Ivydene Care Home DS0000061638.V324107.R01.S.doc Version 5.2 Page 21 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 OP27 Regulation 18(1)(a) Requirement The registered person must ensure there are sufficient staff on duty at all times to ensure residents needs are met in a timely fashion. Previous date for completion Not met 01/08/06 Timescale for action 01/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 2. Refer to Standard OP7 Good Practice Recommendations To ensure the changing needs of residents are recognised and a plan to meet them is in place, all care plans should be reviewed at, at least monthly intervals with involvement form residents and or their representatives. Ivydene Care Home DS0000061638.V324107.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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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