CARE HOMES FOR OLDER PEOPLE
Leahyrst Care Home 20 Upperthorpe Sheffield South Yorkshire S6 3NA Lead Inspector
Shirley Samuels Unannounced Inspection 10th November 2008 09:00 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 DS0000068204.V373008.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. DS0000068204.V373008.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Leahyrst Care Home Address 20 Upperthorpe Sheffield South Yorkshire S6 3NA 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) 0114 272 2984 0114 273 0441 None Silver Healthcare Limited Post vacant Care Home 41 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (30), Mental disorder, excluding learning of places disability or dementia (32), Old age, not falling within any other category (9) DS0000068204.V373008.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. All 32 of the DE beds can be MD instead. 30 of the DE beds are for people 65 years and over. Date of last inspection 7th November 2006 Brief Description of the Service: Leahyrst is situated in the Upperthorpe area of Sheffield close to local shops, other amenities and the tram and bus routes. The building is purpose built and has three floors accommodating service users who require dementia and general personal care. The home is registered for 41 places. A variety of communal seating and dining areas are provided. The home has a sufficient number of baths, toilets and showers. A commercial type laundry serves the home and kitchen.35 bedrooms are single, and 3 bedrooms are double. Six of the single rooms have en-suite toilets. The home is accessible to service users, ramps and a lift are available, and aids and adaptations are in place. The home has a pleasant enclosed garden. Car parking is available. The individual persons owning Leahyrst remained unchanged, however, a limited company took over the ownership of the home in October 2006. We were told that the current fees range from £327.00 £404.00 Additional charges included hairdressing, newspapers and private chiropody. DS0000068204.V373008.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means people who use the service experience good quality outcomes.
“We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken.” This was a key inspection carried out on this service by Shirley Samuels on the 10th November 2008 from 9:30am-5:15pm. In the report we make reference to “us” and “we”, when we do this we are referring to the inspector and the Commission for Social Care Inspection. On the day of the visit we spoke to three people using the service, three staff, three relative and the manager of the home. Before the visit we received comments about the quality of the service from three people using the service, seven staff and one professional visitor. All the comments received were positive and reflected good standards of care for people. People who live in a care home and find it difficult to communicate with our inspectors will now get the chance thanks to a new observation technique. When visiting a home, inspectors will watch how people with dementia or a learning disability behave to find out what they think of the care they receive. The tool, called the Short Observation Framework for Inspections (SOFI), has been developed between us and the University of Bradford. This tool was used during this inspection. We spent two hours in one of the lounges making observations of the care and interaction between staff and people using the service. This aids us in making a judgement about the standard of care and the outcomes for the people using the service During this visit we looked at the environment, and made observations on the staff’s manner and attitude towards people. We checked samples of documents that related to people’s support, care and safety. These included three assessments and care plans, three medication records, and three staff recruitment files. We looked at other information before visiting the home. This included the Annual quality assurance assessment (AQAA). This is a form completed by the owner and the manager of the service which tells us how they think the service
DS0000068204.V373008.R01.S.doc Version 5.2 Page 6 is doing, what has improved and what further action they plan to take to develop the service. The inspector would like to thank everyone for their cooperation and welcome. What the service does well: What has improved since the last inspection?
Details of people’s moving and handling requirements form part of the care plan. There are safe systems in place for the disposal of medication. An
DS0000068204.V373008.R01.S.doc Version 5.2 Page 7 activities coordinator has been employed to enhance the social and creative aspect of people’s lives. To reduce the risk of injury water temperatures are checked and recorded. Staff have received further moving and handling training to make sure they have the skills and knowledge to move people safely. 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. DS0000068204.V373008.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000068204.V373008.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People using the service experience good outcomes in this area This judgement has been made using available evidence including a visit to this service. People’s needs are assessed before moving into the home. The home does not provide intermediate care. EVIDENCE: Each person’s file contained an assessment of care. This assessment detailed people’s needs and level of support needed. Staff told us in the main they received the information they needed which helped them to make a decision about whether they could met people’s needs. DS0000068204.V373008.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People using the service experience good outcomes in this area This judgement has been made using available evidence including a visit to this service. Staff understand people’s needs, health care needs are met, the medication system is safe and people are treated with respect and dignity. EVIDENCE: In the AQAA the manager told us people’s health care needs are met and that people’s needs are recorded in a plan of care. She added that in the last year a more effective medication system has been introduced and training provided for staff. Each person had a plan of care that detailed their needs and the action staff needed to take. Relatives told us they are able to contribute to the plan of care by sharing information when the person using the service is less able to do this. This made sure that staff had the information they needed to support people appropriately. DS0000068204.V373008.R01.S.doc Version 5.2 Page 11 Records of care given were kept. Each care need had a corresponding number and the records of care given often-recorded “care given as in care plan”. This did not in enough detail reflect the care given (in relation to the care plan) and the outcomes for people using the service. The records did however include information about events that happened outside of the care plan for example a fall, a visit by a relative or a visit by a health professional. The records of care plan reviews stated the date and “No change this month”. This meant reviews did not reflect an overview of outcomes for people over the last month and any changes. Relatives told us that peoples health care needs were met. On the day of the visit people received visits from health care professional including district nurse and GP. Records of visits were kept and detailed instructions for staff. Records also included details of visits by the dentist, optician, and chiropodist. Relative’s also told us that the staff kept them up to date about any changes in people’s condition. This means that people health care needs were met. Records were kept of medication-received into the home. They were appropriately stored and administered. Staff responsible for administering medication are trained and there are procedures in place to monitor the medication system. The manager told us where shortfalls were found these were addressed with individuals. This means the medication system is safe and people are protected. Observations made on the day of the visit showed that people were treated with respect and dignity. People using the service and relatives told us that “staff were wonderful and they could not ask for better”. Staff were able to give us some examples of how on a daily basis they respected people’s rights to dignity and respect. For example offering choice giving information, knocking on doors and offering privacy and dignity during personal care tasks. This shows that people’s rights are upheld. DS0000068204.V373008.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People using the service experience good outcomes in this area This judgement has been made using available evidence including a visit to this service. Activities were provided; people were encouraged to make choices and to keep in contact with family. People enjoyed positive mealtime experiences. EVIDENCE: In the AQAA the manager told us people have a choice of daily life and activities and that individual dietary needs are catered for. People told us that activities did take place and there were records in people’s files to show what activities they had taken part in. On the day of the visit there were no structured activities but staff were observed making conversation and playing music which some of the people enjoyed. Relatives spoken to told us they were made welcomed when they visited and staff told us they encourage relatives to maintain contact and to play an active role in the life of the person using the service. DS0000068204.V373008.R01.S.doc Version 5.2 Page 13 Staff were able to give us examples of how they promoted choice. People were given information, given visual choices and encouraged to choose. Staff told us having the information they needed talking to family and people using the service helped them to make choices for people if they were less able to make them for themselves. This made sure that people had as much control over their life as they could. People told us they were happy with the food provided. Special diets were catered for there was variety and choice. People who needed assistance with feeding were supported in a dignified manner and people who were reluctant to eat were gently and appropriately encouraged. DS0000068204.V373008.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and18 People using the service experience good outcomes in this area This judgement has been made using available evidence including a visit to this service. Complaints were taken seriously and people were protected from harm. There were some shortfalls in recordings of complaints. EVIDENCE: In the AQAA the manager told us complaints documents are provided to people using the service and for visitors. All staff have received training on safeguarding adults and all have an understanding of their responsibility for the protection of people. The home does have a complaints procedure and a format for responding to complainants. There are no records of any complaints since the last inspection. From our records however we know that the home has had a complaint, which they investigated and responded to the complainant. People told us they knew how to make complaints. Relatives told us “little niggles” were sorted out quickly. Staff had received training on the safeguarding and were able to give examples of abuse and how on a daily basis they protected people from harm. One complaint made to the home also generated a referral to the Sheffield Social
DS0000068204.V373008.R01.S.doc Version 5.2 Page 15 Services safeguarding team. The formal outcome of this referral is still out standing. DS0000068204.V373008.R01.S.doc Version 5.2 Page 16 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 and 26 People using the service experience good outcomes in this area This judgement has been made using available evidence including a visit to this service. The home was well maintained clean and hygienic. EVIDENCE: In the AQAA the manager told us since the last inspection some bedrooms have been refurbished new furniture, carpets and lighting. There have also been improvement of communal areas which has enhanced the environment for people using the service. People told us they were happy with their bedrooms, they were clean and personalise. The home was well maintained there is a programme of ongoing maintenance and refurbishment. This made sure the environment was well maintained clean and comfortable for people.
DS0000068204.V373008.R01.S.doc Version 5.2 Page 17 Staff told us they had the equipment and materials to maintain good levels of hygiene and infection control. DS0000068204.V373008.R01.S.doc Version 5.2 Page 18 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 and 30 People using the service experience adequate outcomes in this area This judgement has been made using available evidence including a visit to this service. There are enough trained staff on duty. There are some shortfalls in the recruitment procedures. EVIDENCE: In the AQAA the manager told us that staff receive training to National vocational level 2 and 3 in care. She added the home has robust procedures for the recruitment of staff to make sure that people are safe. The rota shows there is enough staff on duty to meet people’s needs. Staff told us the staff team worked well together. Staff were able to tell us what their jobs were and how they improved the quality of life for the people using the service. The staff files checked contained the majority of the information required. They included employment history, health and criminal records checks, photographs and identification. On each of the three files checked there was only one reference. This was brought to the attention of the manager. The day following the inspection the administrator confirmed that verbal references had been obtained with written ones to follow.
DS0000068204.V373008.R01.S.doc Version 5.2 Page 19 The manager told us the home employed 21 staff and 19 staff are trained to National Vocational Qualification NVQ level 2 our above. This shows staff receive the training they needs to do their job. DS0000068204.V373008.R01.S.doc Version 5.2 Page 20 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, and 38 People using the service experience good outcomes in this area This judgement has been made using available evidence including a visit to this service. The home is well managed and is run in a way that promotes the best interest of people using the service. EVIDENCE: In the AQAA the manager told us the home has a positive style of management. The owner visits the home monthly and carries out checks on the quality of the service. There has been a change of manager since the last inspection. People spoke positively about the manager and said the home was well run.
DS0000068204.V373008.R01.S.doc Version 5.2 Page 21 People using the service and their relatives are asked to comment on the way the home is run. Evidence of feedback was seen on the day of the visit. This information was in the process of being put together in a format that could be shared with people using the service staff and relatives. People told us they were happy with the arrangements for the management of their money. The home encouraged family to manage finances and only managed the finances of a few people. We were told that accounts were held for individuals there was a float at the home so people could access money and people received interest on any money banked on there behalf. This made sure that people’s financial interests were safeguarded. Staff were observed using safe moving and handling techniques. Staff understood their responsibility for the health safety and welfare of the people using the service and for themselves. There were procedures in place to ensure the monitoring of and servicing of equipment and services. Staff received health safety and fire training and understood their responsibility for reporting any hazards. This made sure the health safety and welfare of people was promoted. DS0000068204.V373008.R01.S.doc Version 5.2 Page 22 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 3 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 2 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 DS0000068204.V373008.R01.S.doc Version 5.2 Page 23 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 OP16 Regulation 22 Requirement Timescale for action 20/12/08 2 OP29 19 schedule 2 A record of all complaints must be kept including the details of the complaint the outcome of the investigation and response to complainant and whether the complainant was happy or not. As part of the recruitment 20/12/08 procedures two references must be obtained before staff start working in the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP7 Good Practice Recommendations Records of care given should include full details and should not only record “care given as in care plan” Records of reviews should reflect significant events and outcomes for people over the previous month and any changes. These should then be incorporated into the care plan. Detailed records of care given should be used to inform the care plan review.
DS0000068204.V373008.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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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