CARE HOMES FOR OLDER PEOPLE
James Dixon Court Harrops Croft Netherton Liverpool Merseyside L30 0QP Lead Inspector
Mrs Julie Garrity Unannounced Inspection 12th January 2006 10:40 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 James Dixon Court DS0000005406.V278148.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. James Dixon Court DS0000005406.V278148.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service James Dixon Court Address Harrops Croft Netherton Liverpool Merseyside L30 0QP 0151 931 5748 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) Arena Housing Association Limited Mrs Christine Cole Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places James Dixon Court DS0000005406.V278148.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 18 OP Date of last inspection 04/10/05 Brief Description of the Service: James Dixon Court is a Home registered to provide personal care for up to 18 older people of both sexes. (A variation to increase this capacity is currently being processed by CSCI). Arena Housing Association, whom provides a range of services as a registered charity, owns the Home. Accommodation is in single rooms, all with en-suite facilities. Sheltered accommodation is also managed by Arena, this is adjacent to the Home, and the whole complex is in a large residential area near to local facilities and transport links. Communal facilities consist of a large lounge/dining room, and a separate smoking and sitting area. Gardens to the rear are used when weather permits. There is parking to the front of the building, which is well used by service users, families and staff. James Dixon Court DS0000005406.V278148.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 1 day and was a total of 4 hours and 45 minutes. It was a routine unannounced inspection. A tour of the premises took place, twelve residents, two relatives, five staff and a senior carer were spoken with. The manager was unavailable for the inspection. A variety of records were reviewed including the care records of four residents, medication, accident records, staff training and risk assessments. A brief review of the premises was also part of the inspection. What the service does well: What has improved since the last inspection? What they could do better:
Residents are happy with the food provided but are not always aware the different choices available for them. The home will need to monitor the levels of accidents of the residents and make sure that the risk assessments for residents detail the actions that staff need to take to reduce potential accidents.
James Dixon Court DS0000005406.V278148.R01.S.doc Version 5.1 Page 6 There is a high level of unobserved accidents that reflects that staffing levels are not being monitored to make sure that they meet resident’s needs. Residents and staff said that, there was not enough staff available due to long term absence of two senior members of staff. There is a variety of training for the staff but senior staff need to have a better understanding of their role in any complaints or Protection of Vulnerable Adults investigations and kitchen staff would benefit from training in dealing with diabetic diets. All new staff must have an induction when they start in the home. Fire doors were not closing properly in the home. Arena Housing were contacted and arranged to have a maintenance team address this and other health and safety concerns promptly. 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. James Dixon Court DS0000005406.V278148.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 James Dixon Court DS0000005406.V278148.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): None of the standards in this section were fully reviewed. EVIDENCE: The home has had an extension recently built. New residents are transferring from James Horrigan which is another home owned by Arena Housing. All of these residents who are moving to James Dixon have been assessed by the home and social services in order to make sure that James Dixon Court can care for their needs. James Dixon Court DS0000005406.V278148.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Medication management has significantly improved. The staff are meeting good practice guidelines in order to give out medications safely. EVIDENCE: Medication records are clear. Photographs of residents are available that allow staff to make sure that they are giving out the medications to the right person. One resident explained that she likes her medications at “certain times and the staff make sure I get them then”. Medications are clearly recorded on arrival and when they are not given. Handwritten medication records need staff to sign and have another member of staff check that the entries are correct and sign, so two signatures are available at all times. This is done to make sure that the medications are written correctly. Where medications say one or two to be given staff have not always detailed if one or two have been given. This needs to be done in order that the home can manage the medications and know if they have enough stock to meet the needs of the residents. James Dixon Court DS0000005406.V278148.R01.S.doc Version 5.1 Page 10 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): 15 The residents in the home enjoy the food provided. The dinning room is well presented and comfortable. Not all the residents are aware that there is a choice of food available. EVIDENCE: A menu is available that is written for each meal in the main dinning room. The meals were well presented and residents with said, “the food is good and tasty”, “good home cooking that’s really nice” and “I like the food here”. There is a large dinning room with sufficient tables for all the residents to sit at. The tables were laid before each meal and staff were available to assist the residents if needed. A new dinning room has been built but is not in use as yet as the home needs to wait for official approval from fire service. The cook keeps a record of resident’s choices for food and those that they would prefer to eat. On the day of inspection the menus did not detail any choice of meals. Staff detailed that if residents did not like the food on offer an alternative would be given. One resident was not aware that a food choice was available, the main meal was fish the resident explained that she didn’t “particularly like fish”. Residents were not asked if they wanted the meal on offer or would require an alternative. There were no menus that detailed alternative diets such as diabetic diet. There are several residents who have diabetes and would benefit from the home providing information as to the availability of diabetic diets. The kitchen staff have not received training in catering for diabetics and the staff.
James Dixon Court DS0000005406.V278148.R01.S.doc Version 5.1 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 A complaints procedure is available that would assist residents and staff in raising concerns. The senior staff do not fully understand how Protection of Vulnerable Adults concerns would be dealt with. This runs the risk of that an allegation in this area would not be dealt with in appropriate manner. EVIDENCE: A complaint made to the home via Commission for Social Care Inspection was dealt with appropriately. The home undertook a full and proper investigation and addressed the concerns raised appropriately. A copy of the complaints procedure is available for the residents and families. A family member spoken with said “I’ve never had a reason to complain if I want to question something or find out about something the staff have always been very helpful and explained it properly for me”. Two residents spoken with said, “never had a problem” and “when I did need something the staff sorted it out for me, they are very supportive, kind and helpful”. The majority of staff have received training in Protection of Vulnerable Adults and an extensive policy including how staff raise concerns was available. However discussion with the senior staff detailed that they had little understanding of what would happen if a complaint was raised and how to prevent the investigation from being ruined. The procedure available was confusing and did not detail to the staff their role. The manager is on longterm leave and senior staff would be responsible for addressing this in the event of a complaint.
James Dixon Court DS0000005406.V278148.R01.S.doc Version 5.1 Page 12 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): None of the standards within this section were fully reviewed. EVIDENCE: The new extension has now been built, the home is waiting for this to be viewed by the fire authority before they can use it for the new residents. Many of the areas such as the corridors have been redecorated and new furniture is available throughout the home. The walls of the new unit are bare and in need of pictures, these are on order and will be in place before the home admits its first new resident. Residents spoken with said, “it looks lovely now”, “I like the new furniture” and “looking forward to using the new dinning room”. A relative said, “the home always looked good, but it looks really great now”. James Dixon Court DS0000005406.V278148.R01.S.doc Version 5.1 Page 13 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, 28, 29, 30 Staff receive training suitable to the needs of the residents. Due to longer term sickness there is not enough staff to fully meet the residents needs. The lack of all staff receiving a full induction places residents at risk. EVIDENCE: Staff receive training in many areas, including medications, moving and handling, fire safety, Protection of Vulnerable Adults, diabetes and dementia. However not all staff receive training in these areas. One resident said “staff are great, they are kind, helpful and know what they are doing” a relative said “I think the staff get a lot of training, I’m not sure what that is but they always appear to know their jobs”. Several staff have done a training course specifically for care assistants. Recruitment of new staff is undertaken with the assistance of head office. All but one of the records viewed had references, police checks and Protection of Vulnerable Adults checks for staff members as needed. One recently recruited staff member did not have these on file. These were forwarded to CSCI a few days later. The same member of staff had not received an induction into the home and was therefore not able to fully meet the needs of the residents. Staff members detailed that the manager and a senior carer has been of for an extend period of time. Staff said “we don’t have enough staff at the moment”. Of the residents spoken with two confirmed that recently staff were “a lot more rushed” and that “it seems to take them a bit longer to help me”.
James Dixon Court DS0000005406.V278148.R01.S.doc Version 5.1 Page 14 Staffing levels are not regularly reviewed to make sure that there are enough staff to meet the residents needs. Accident records also supported that there were insufficient staff available there are high levels of falls for residents, the majority of these were not observed by anyone and occurred either at busy times of the day or overnight. James Dixon Court DS0000005406.V278148.R01.S.doc Version 5.1 Page 15 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): 35, 38 Resident’s finances are handled by themselves or their families as much as possible. Where the home is involved the residents are safeguarded. Health and safety needs such as risk assessments and fire systems are in need of updating in order to fully protect the residents. EVIDENCE: Each resident has a safe available in his or her bedrooms. Residents or their relatives look after their money. Records detailing the money in and out of the safe are kept. However receipts of spending are not kept. Risk assessments for residents are available but they do not reflect the actions that staff need to take in order to reduce the residents risks. Three residents were identified as having three or more falls in the last twelve months only one of these had a risk assessment or any details in the residents care plans. The majority of falls were unobserved with most falls occurring early in the morning or overnight.
James Dixon Court DS0000005406.V278148.R01.S.doc Version 5.1 Page 16 Risk assessments were not available for residents that smoked and there were no indications as to whether staff needed to supervise the residents or not. All the fire doors apart from the day room door on the new building and several doors in the old building did not close properly. Arena Housing were contacted and arranged for these to be addressed the following day. The fire door of the kitchen was propped open. Arena Housing arranged for this to be addressed within the next week. James Dixon Court DS0000005406.V278148.R01.S.doc Version 5.1 Page 17 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 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 X X X X X X X X STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 2 James Dixon Court DS0000005406.V278148.R01.S.doc Version 5.1 Page 18 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 OP18 Regulation 13 (6) Requirement All senior staff must be aware of their role within any Protection of Vulnerable Adults investigation and how any investigation would be undertaken. Residents dependency needs must be determined at regular intervals, in order that the manager can ensure that there are sufficient care staff available to meet the dependency needs of the service users cared for. All staff must receive an induction that meets National Training Organisation standards and informs staff of how to meet the resident’s needs. Risk Assessments must be available with an identified risk. The risk assessment must be reflected within the residents care plans and identify how staff are to try to reduce the risk to the residents The Home must make sure that they complete fixing the fire doors as detailed to CSCI. Timescale for action 12/04/06 2. OP27 18 (1) (a) 12/02/06 3. OP30 18 (1) (c) 12/02/06 4. OP38 13 (4) (a) (b) (c) 12/03/06 5. OP38 23 (4) (c) (i) 26/02/06 James Dixon Court DS0000005406.V278148.R01.S.doc Version 5.1 Page 19 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 OP9 Good Practice Recommendations All handwritten medications should have two signatures. Medications prescribed as one or two tablets to be given should be recorded as to whether on or two tablets were given. The different choices available should be detailed to residents at every meal. Residents should be asked as to their preferences before the meal is served. The cook and kitchen staff should receive training in diabetic diets and reflect this on the menu choices available. The pictures removed for redecoration should be returned to the main corridors. All staff recruitment records such as Protection of Vulnerable Adults, Criminal Records Bureau checks and references should be forwarded to the home for the manager to review. The home should keep receipts for any monies spent on behalf of the residents such as hairdressing. The manager should regularly audit the accidents in the home to identify particular residents, times, places or equipment. 2. 3. 4. 5. OP15 OP15 OP19 OP29 6. 7. OP35 OP38 James Dixon Court DS0000005406.V278148.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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