CARE HOMES FOR OLDER PEOPLE
Ivydene Care Home Staniforth Drive Ivybridge Plymouth Devon PL21 0UJ Lead Inspector
Fiona Cartlidge Unannounced Inspection 17th January 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.V269984.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. Ivydene Care Home DS0000061638.V269984.R01.S.doc Version 5.1 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 Mrs Veronica J Stewart 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), Terminally ill over 65 years of age (5) Ivydene Care Home DS0000061638.V269984.R01.S.doc Version 5.1 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 12th October 2005 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 a passenger lift 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. Ivydene Care Home DS0000061638.V269984.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 5 hours 30 minutes and was unannounced. This was the homes second statutory inspection of the year 2005-2006 readers may wish to consider the content of both reports to gain a full picture of the homes achievements. A partial tour of the home took place when some bedrooms and all communal areas were viewed. Individual records of care held on behalf of 5 residents were inspected. The inspector spent the majority of the time talking with 25 residents and 1 visitor and took time observing actual practise. What the service does well: What has improved since the last inspection?
The choice of meals has improved and residents confirmed that if they did not like either of the advertised main dishes an alternative to the menu would be offered. Ivydene Care Home DS0000061638.V269984.R01.S.doc Version 5.1 Page 6 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. Ivydene Care Home DS0000061638.V269984.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 Ivydene Care Home DS0000061638.V269984.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): 3,5 The admission process is safe for most people being admitted to the home. Most people are invited to visit the home before making a decision about admission. EVIDENCE: The inspector examined the personal records held within the home on behalf of 5 residents; all contained evidence that a full and detailed assessment had been performed on the resident prior to their admission. The inspector found that information about the individuals’ health, personal and social care had been sought to enable the registered nurses to make a professional judgement about how needs will be met before offering the individual the opportunity of admission. Seven bedrooms are dedicated to persons receiving short term nursing care funded by the NHS, the manager stated that people using these beds, do not have the opportunity of being assessed by staff from the home before their admission, this poses a risk as the homes staff are best placed to be able to confirm what needs the home is able (or not) to meet. Ivydene Care Home DS0000061638.V269984.R01.S.doc Version 5.1 Page 9 The partner of one recently admitted resident told the inspector how much they had appreciated being able to visit the home days before the residents admission to bring in personal articles to make sure the environment was as suitable and homely as possible. Another recently admitted resident had known the home very well before they had agreed their admission as their wife was an existing resident in the home and had been so for over a year. Ivydene Care Home DS0000061638.V269984.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): 7,8,9 Most residents have a clear documented plan of care, for those that do not; there is a risk that the persons needs will not be met in their entirety or in a consistent way. The health care needs of residents are regularly reviewed and action is taken to meet those needs. The homes medication system is well managed and safe. EVIDENCE: The inspector examined the personal records held on behalf of 5 residents; in 4 of these documented assessments were seen and provided information about skin integrity, moving and handling, safety - including risk of falls, and 3 contained information about social needs. The information generates the plans of care, which provide the basis for the care to be delivered. In the case of one resident there was no documentary evidence that they had, had any of their needs assessed since their admission or a documented plan of care. 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, occupational therapists, physiotherapists and dentist’s visit.
Ivydene Care Home DS0000061638.V269984.R01.S.doc Version 5.1 Page 11 Records of outpatient appointments show that visits to community and hospital health resources are enabled. The medication system is managed by registered nurses; the inspector looked at storage and recording – controlled drug stock was checked against records and found to be correct The required controlled drug stock meant that the cupboard used for its storage was over full posing a risk that medication may fall to the floor as the door was being opened. 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. Ivydene Care Home DS0000061638.V269984.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): 12,13,15 Social activities are organised and meet the needs of the residents. Meals are nutritious and balanced and offer a healthy and varied diet for residents. The arrangements for residents to receive visitors are good. EVIDENCE: Some residents were seen socialising in the lounge or watching television others were spending time in their rooms, reading, listening to music, watching television and one was busy model making. A monthly news - letter is distributed to residents to provide information about the social activities available, those in January include exercise classes, poets corner, bingo, knitting circle, communion and entertainment by an organist. Residents told the inspector they are able to chose the times they rise and retire and when, where and how they spend their time. The feedback about food was positive all of the residents spoken to said how good it was; on the day of inspection lunch was served, residents were offered Roast beef with Yorkshire puddings, vegetables and potatoes followed by ice cream or fruit and cream; residents said they are always offered 2 choices and if neither suit an alternative is found. Most residents ate lunch in the dining room a few who required assistance were given this individually in a timely and
Ivydene Care Home DS0000061638.V269984.R01.S.doc Version 5.1 Page 13 respectful manner. Some residents ate their lunch in their own accommodation. Residents said they have breakfast in bed at about 8.30am, lunch is served at 12.30pm, and evening meal at 5.00pm and a night drink and biscuits is served at about 8.00pm. One resident said they were always offered the selection of sandwiches at tea - time last and all the best ones had gone. Records seen provided evidence that it is usual practise for residents to undergo nutritional screening and have a nutritional care plan, which expects resident’s weights to be regularly monitored. 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.V269984.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 People’s complaints will be listened to, taken seriously and acted upon. EVIDENCE: The complaints procedure is communicated to residents and/or their representatives. A notice explaining the procedure was found displayed in the entrance hall, Statement of Purpose and Service Users Guide, the information is in enough detail to ensure people have the means to refer a complaint to the Commission at any time. The commission has received 1 complaint about this home since its last inspection. The complaint has been passed to the registered manager to investigate and who will report back to both the complainant and the commission with records of the investigation and outcomes and any actions taken (if needed) to prevent a reoccurrence. Residents told the inspector if they had issues or concerns they would speak to the matron/manager who is ‘very approachable’, and asks regularly if residents have any problems. Ivydene Care Home DS0000061638.V269984.R01.S.doc Version 5.1 Page 15 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): 19,22,26 The home is simply decorated and furnished and clean, pleasant and hygienic. EVIDENCE: A tour of the home showed that resident’s rooms contain 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. 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. It was noted that the nurse call system is not accessible to immobile residents in the communal rooms, this risk to safety and possible bar to meeting peoples needs was discussed with the homes manager at the time of the inspection. The gardens are safe and accessible and have recently been improved to provide an even better seating area for residents next summer. Specialist mattresses were seen in place for those residents requiring them, as were height adjustable beds.
Ivydene Care Home DS0000061638.V269984.R01.S.doc Version 5.1 Page 16 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. The liquid soap dispenser in 1 bathroom was missing although there was still a container of soap. Ivydene Care Home DS0000061638.V269984.R01.S.doc Version 5.1 Page 17 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 The number and skills of staff available in the home meets the needs of those living in the home. EVIDENCE: The residents spoken to said there was usually enough staff on duty, 2 residents commented on how busy the staff are during the day and that sometimes the length of time it took staff to respond to the call bell was unacceptable. All but one of the residents spoke well of the night staff saying they were particularly good. All residents spoken to said their needs were being met. Residents described staff as hard working, kind and respectful. Ivydene Care Home DS0000061638.V269984.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): 38 The provider demonstrates a responsible attitude towards health and safety issues. EVIDENCE: This standard was not fully inspected on this occasion, information about safe maintenance systems were examined last October at the time of the last inspection and were satisfactory. The inspector did observe during this inspection - emergency safety notices displayed in the home including the procedure to follow in the event of fire, resident’s individual assessments documented on risks associated with their care. Notices displayed in the office indicating that all staff receive video training sessions on fire safety, food hygiene, manual handling and infection control. Ivydene Care Home DS0000061638.V269984.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 2 X 2 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Ivydene Care Home DS0000061638.V269984.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 15 Requirement Every Service user must have a plan of care based on a full assessment of their needs. An accessible system must be available in communal rooms for immobile residents to be able to summon assistance when staff are not in attendance. Timescale for action 01/02/06 2. OP22 13(4) 01/04/06 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 OP3 Good Practice Recommendations To ensure Ivydene meets the needs of residents admitted at short notice into the beds contracted by the NHS, the registered person should ensure the staff in the home have sufficient information about the individual to make an informed professional decision about if/how all their needs can be met and if they feel they cannot meet the
DS0000061638.V269984.R01.S.doc Version 5.1 Page 21 Ivydene Care Home 2 OP5 3 OP9 individuals needs staff should refuse their admission or have access to assess them before making a decision. All prospective residents or their representatives (including those admitted into the NHS contracted beds) should be given the opportunity to visit the home before making a decision about admission. Consideration should be given to providing a larger safe storage cupboard for controlled medication. Ivydene Care Home DS0000061638.V269984.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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