CARE HOMES FOR OLDER PEOPLE
Lady Spencer House 52 High Street Houghton Regis Bedfordshire LU5 5BJ Lead Inspector
Dragan Cvejic Unannounced Inspection 13th October 2005 07:30 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 Lady Spencer House DS0000014923.V259090.R01.S.doc Version 5.0 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. Lady Spencer House DS0000014923.V259090.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Lady Spencer House Address 52 High Street Houghton Regis Bedfordshire LU5 5BJ 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) 01582 868516 01582 868516 Resicare Homes Limited Mrs Jean Flanagan Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24), of places Physical disability over 65 years of age (24) Lady Spencer House DS0000014923.V259090.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th April 2005 Brief Description of the Service: Lady Spencer House is a residential home for older people, specialising in the care of people with mental and physical disabilities. The home was situated within walking distance of the centre of Houghton Regis, and also provided easy access to the town’s amenities. It is a modern, purpose built house and with three floors, it offered accommodation of 24 single rooms. The communal space included 3 comfortable lounges for service users to sit together, and the staff are able to spend time with them, paying attention to all individuals. A lift was used for access to the first and the second floor. A number of toilets and washing facilities were located throughout the building, allowing easy access. The parking space behind the building and a small garden was sufficient for staff and visitor’s cars. Lady Spencer House DS0000014923.V259090.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. It was carried out over a 4 hours period. The Environmental Health Officer – inspector - (EHO) was present and the inspection was carried out co-operatively. Three service users were case tracked, meaning that their files, bedrooms and other relevant aspects were inspected in relation to them as individuals. The manager and a new, proposed manager were carrying out an induction for the new manager. Plans are in place for the post to be taken up in February 2006. Five service users, three staff members and the managers were spoken to. The inspector also spoke by telephone to the owner who was away on holiday, but had called to check that everything was all right. Three bedrooms were checked, as well as communal areas: a dining room and a lounge. The kitchen was inspected jointly with the EHO inspector and she provided her own feedback and requirements, such as, to fit a missing skirting board etc. The requirements from the last inspection were not met, but were discussed and the extended time scale for compliance was agreed. What the service does well: What has improved since the last inspection? Lady Spencer House DS0000014923.V259090.R01.S.doc Version 5.0 Page 6 A new carpet was laid in the lounge. The kitchen was much cleaner than on previous inspections, but would still need to be repainted, as planned. A new manager was instructing staff how to accurately administer medication and record this correctly. She also explained, and the medication file confirmed, how the amount of medication was monitored and how the home would react to prevent any shortage of a specific medication. Service users’ risk assessment forms were devised and they had started to be used and were cascaded through the care planning process to be carried out during the review for each individual. 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. Lady Spencer House DS0000014923.V259090.R01.S.doc Version 5.0 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 Lady Spencer House DS0000014923.V259090.R01.S.doc Version 5.0 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): 1,3,4,5, The home did not have up to date written information about the home to give to any potential service users. However, the assessment of new service users was carried out in detail and ensured that their needs would be met when admitted. EVIDENCE: The home’s statement of purpose and the service user’s guide were not reviewed to illustrate an up to date offer of provisions and services. Contracts were not held in this home due to a lack of space, but at the “sister” home where the head office was placed. The manager stated that contracts could be faxed at any time on request. The home carried out a comprehensive pre-admission assessment and held copies of this in each individual file. This assessment exceeded standards on a previous inspection and remained of the same quality. Service users spoken to confirmed that they were assessed prior to admission. Service users spoken to stated:”They look after us properly, we get nice food and everything”. The other users spoken to also confirmed that their needs were met.
Lady Spencer House DS0000014923.V259090.R01.S.doc Version 5.0 Page 9 Two service users confirmed that they visited the home prior to admission and that a trial period for them was set. Lady Spencer House DS0000014923.V259090.R01.S.doc Version 5.0 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 Personal and healthcare needs of service users were met, as they confirmed and the documentation illustrated. EVIDENCE: Care plans inspected demonstrated that all health care needs were assessed and addressed in the plans. The service users’ files contained: an initial care agreement in which service users answered questions of how they liked to receive care and support; a brief description that provided information in a concise history with current needs described in general terms; a care plan that provided detailed information on the needs and how they were going to be met and a risk assessment which assessed the associated risks of the addressed needs from the care plans. Care plans were not signed in all cases by service users or their representatives. This issue was discussed and it was agreed that service users or their representatives would sign the front page with a summary of the needs. This way their dignity would be more respected and the more sensitive areas described in care plans that could potentially cause offence would be carefully worded. The key workers would explain tactfully, any issues from the care plans to the service users. Lady Spencer House DS0000014923.V259090.R01.S.doc Version 5.0 Page 11 The new format for risk assessment was an excellent document created by the new, proposed manager. The home started replacing the previous risk assessments on a cascaded time scale, when new care plans were drawn. Routinely knocking on the door of service users’ rooms, was an element that demonstrated a high level of respect for privacy and dignity. Service users confirmed that they “could do what they wanted”. The medication process was significantly improved, not only from an administrative point of view, but also of monitoring and respecting users that wanted to partly self administer their medication. An area for improvement was identified in recording one or two administered tablets, when the prescription suggested this to be the case and needs led. The trainee manager was exploring the way to accurately measure administering liquidised medication. Lady Spencer House DS0000014923.V259090.R01.S.doc Version 5.0 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): 12,13,14, The home continued to provide a satisfactory daily routine, as service users wanted, and were considering users suggestions, to ensure that they remained in control over their lives as far as possible. EVIDENCE: Several service users confirmed that their voice was heard and daily routine was created as they wished. They stated that activities were of their choice and stimulating enough to their expectations. One service user had full control of her finances. A few more had some of their personal allowances with them. Some were helped by families and all were provided with information about contacting independent advocates if they wanted to be helped with their finances. The home did not have a permanent cook at this time, but the post was advertised for. Temporary cover was arranged and the management aspect of catering provision was planned to be corporately organised with the catering manager from the “sister” home being responsible. Lady Spencer House DS0000014923.V259090.R01.S.doc Version 5.0 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 the following standard(s): none These standards were not inspected on this occasion, as they were continuously met on the previous inspections. EVIDENCE: Lady Spencer House DS0000014923.V259090.R01.S.doc Version 5.0 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 the following standard(s): 19,24,25,26 Service users benefited form the pleasant, well maintained and homely environment in the home. EVIDENCE: Thee service users showed their rooms to the inspector and commented that they had all they needed. The rooms were clean and pleasant. One user proudly stated: “These pieces of furniture are mine, I brought them in with me when I moved in.” The kitchen was inspected jointly with the EHO inspector who commented that great improvements had been made. There were however, still a few requirements to be carried out. The home was clean, bright and without offensive odours. Water temperatures checked were within the required range. Lady Spencer House DS0000014923.V259090.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29,30 Staff files demonstrated serious omissions in obtaining written documentation for new staff and not ensuring full protection for service users. EVIDENCE: Some of staff files inspected contained only one written reference. A previous requirement was not fully met to create a risk assessment for cases when a second written reference was difficult to obtain. This form had been created since last the inspection but has not been used yet. Obtaining the CRB disclosures continued to represent a problem for the home. The staff files inspected demonstrated that there were staff without CRB disclosures. Some staff had only standard disclosures although enhanced were required and are necessary, to ensure full protection for service users. In one inspected case, a CRB disclosure was dated a few months before the starting date. Training certificates were also in staff files and demonstrated that updated training was not carried out regularly for all staff. However, staff were confident in performing their duties and service users confirmed that staff had sufficient knowledge to support and help them. The induction log was signed in all inspected files. Lady Spencer House DS0000014923.V259090.R01.S.doc Version 5.0 Page 16 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): The home was well managed by the current manager and with a new prospective manager, who was on an induction. Staff were clear of their roles, but the supervision process was slightly behind schedule. EVIDENCE: The home had a new, trainee manager who was helped and inducted by the existing manager. There was a plan for the current manager to be moved to another home. This home would be then managed by the manager currently on induction. This person was qualified to NVQ3 level and had two more units to complete the Registered Manager’s Award. With sufficient experience and commitment, the plan seemed to be a part of the development for the manager and for the home. Staff supervision notes were kept in staff files and demonstrated that during the last two months the process was not regularly updated and the frequency of supervisions was reduced.
Lady Spencer House DS0000014923.V259090.R01.S.doc Version 5.0 Page 17 Lady Spencer House DS0000014923.V259090.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 4 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X 3 3 3 STAFFING Standard No Score 27 X 28 X 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X 2 X X Lady Spencer House DS0000014923.V259090.R01.S.doc Version 5.0 Page 19 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 OP1 Regulation 6 Requirement The statement of purpose and the service user’s guide must be reviewed to illustrate accurately the services and provisions offered. The full enhanced CRB certificates MUST be obtained for staff. The disclosures must not be backdated to the start date. (This is repeated requirement with a new time scale) Two written references must be obtained for all new staff the home employs. The missing second reference for existing staff MUST be covered by the appropriate risk assessment. (This is repeated and reworded requirement that was not met since the last inspection. The new deadline was set) The new manager, currently on induction, must apply for registration as discussed during the inspection by new deadline. (This was requirement from previous inspection, but the home has got a new manager on induction since than)
DS0000014923.V259090.R01.S.doc Timescale for action 15/12/05 2 OP29 19 28/12/05 3 OP29 19 28/12/05 4 OP31 8 10/02/05 Lady Spencer House Version 5.0 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 Refer to Standard OP9 Good Practice Recommendations The home should create a clear written procedure for administering medication prescribed on “one or two tablets” basis and find the best way to accurately measure administering liquidised medication. All staff files should contain training certificates to demonstrate attendance of update training sessions. The supervision process should be reinstated and ensure that staff receive at least 6 supervisions per year. 2 3 OP30 OP36 Lady Spencer House DS0000014923.V259090.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© 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 Lady Spencer House DS0000014923.V259090.R01.S.doc Version 5.0 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
