CARE HOMES FOR OLDER PEOPLE
Leeming Garth Leeming Bar Northallerton North Yorkshire DL7 9RT Lead Inspector
Mary Slattery Unannounced Inspection 22nd November 2005 10:30 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 Leeming Garth DS0000028033.V264749.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. Leeming Garth DS0000028033.V264749.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Leeming Garth Address Leeming Bar Northallerton North Yorkshire DL7 9RT 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) 01677 424014 01677 425121 Southern Cross Home Properties Limited Mrs Sheila Jelley Care Home 55 Category(ies) of Old age, not falling within any other category registration, with number (53), Physical disability (2) of places Leeming Garth DS0000028033.V264749.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2 Named Service Users in category (PD) to receive nursing care and this condition shall cease when the specific arrangements end. 8th June 2005 Date of last inspection Brief Description of the Service: Leeming Garth Care Centre provides general nursing care for up to 53 older people and for two people with physical disabilities. The home is situated in the village of Leeming Bar with close access to the A1. The accommodation is over two floors and there is stair lift and a passenger lift giving access to the upper floor. The home is set in extensive grounds and there is ample car parking facilities for visitors and staff. The home is owned by Southern Cross Properties Limited. Leeming Garth DS0000028033.V264749.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report related to an unannounced inspection carried out on the 22nd November 2005. The inspection took five hours plus 2 hours preparation time. A tour of the premises was carried out, which included the service users private accommodation. A selection of the homes’ records were looked at and time was spent observing the activity in the home, talking and listening to service users and staff. The focus of the inspection was on a number of key standards, inspecting the case records of a number of service users to establish if they corresponded with their experiences of life in the home. The registered manager was available throughout the inspection and the findings were discussed and agreed at the close of the inspection. What the service does well:
Leeming Garth provides nursing care and accommodation for older people and for two people with physical disabilities. The statement of purpose and the service user guide gives information about the home, the facilities, the staff and the type of care service users should expect to receive and there was information about how to make a complaint about any aspect of the service. The staff gather good information about the service users before they are admitted to the home and a care plan is produced to ensure that all staff are fully aware of each individual need and how each need is to be met. Records of all care reviews are kept and details of any contact service users have with external health care professionals. The home is well staffed and the staff employed have the skills and experience needed to provide nursing and personal care to the service users. All of the staff have a training and development programme and they are supervised on a regular basis. The atmosphere was relaxed and the service users contributed to the inspection by expressing their views of the care they are given, the kindness of the staff. Leeming Garth DS0000028033.V264749.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
To carry out a review of the statement of purpose with particular reference to the commitment given to the safety of service users and consider if it is reasonable to expect those service users who wish to have their bedroom doors open to pay for door closures to be fitted. To make sure that all prospective service users are given clear information about what the home provides and what extra service users will have to pay for. As stated in the previous inspection report it is the view of Commission for Social Care Inspection that providers are responsible for the health safety of service users and for the provision of sufficient and appropriate equipment for their health and safety. The qualified nursing staff need to ensure that they keep accurate medication records and to provide evidence to show that the service users receive their medication as prescribed. When an audit of the medication policy and procedure has been undertaken there should be a record made of the actions taken to address any problems that have been identified. Make sure that all service users are safe and that staff are clear about the fire safety arrangements. To cease using wedges to hold fire doors open and to consult with the fire safety department prior to fitting door closures. To make sure all staff are fully conversant with the fire risk assessment and that they clearly understand the risk that they place service users at by not adhering to the fire safety policy and procedure. Make arrangements to provide sufficient assisted bathing facilities for the number of service users that the home accommodates. The lack of these facilities restricts the service users choice about the number of baths the service users can have. The reports produced by the representative of the proprietor on the conduct of the home need to be more detailed and provide evidence that all aspects of the service are monitored and there should be more information about the findings from the visit and of any actions that need to be taken to address areas of concern.
Leeming Garth DS0000028033.V264749.R01.S.doc Version 5.0 Page 7 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. Leeming Garth DS0000028033.V264749.R01.S.doc Version 5.0 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 Leeming Garth DS0000028033.V264749.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 and 6. People are provided with information about what the home offers and information is gathered about people before they are admitted to ensure that their needs can be met. EVIDENCE: There was a statement of purpose and a service user guide available which is currently being updated to include the details of the change of registered proprietor. Assessments are carried out on prospective service users prior to admission except in the situation where an admission is agreed through rapid response. The assessment records looked at were comprehensive and covered all aspects of the service users personal care and nursing care needs. Service users and/or their relatives are able to visit the home to view the premises and facilities, to meet with the staff and other service users prior to moving into the home. The home provides care for people admitted through the rapid response arrangement but there were no service users being cared for through this arrangement at the time of the inspection.
Leeming Garth DS0000028033.V264749.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 and 9. There are systems in place to make sure that the service users health and personal care needs are met. EVIDENCE: Care plans were in place for each service user, which had been developed from the assessments. The care plans set out each individual’s personal, social, nursing need. Risk assessments were in place with clear plans to assist both staff and service users to minimise the risks in relation to falls and the use of bed safety rails. There was information about the arrangements that are in place for regular contact with external health care professional including their general practitioner. There was information about nutritional needs, the prevention and treatment of pressure sores and the pressure relieving equipment that was in use and the management and promotion of continence. Records of any treatments prescribed and administered are recorded and reviewed.
Leeming Garth DS0000028033.V264749.R01.S.doc Version 5.0 Page 11 The daily records kept by staff confirmed the type and level of care given and the outcomes of that care. A number of the service users are frail and spend much of their time being cared for in bed and there was written evidence to show that they were visited and attended to by staff frequently throughout the day and the night. All of the service users looked well cared for and there was a good supply of equipment for the safe moving and handling of service users and for pressure relief. A number of new profiling beds had been purchased and risk assessment of bed safety rails were in place. Arrangements had been made for suitable weighing scales for those service users who are unable to use a conventional chair type weighing scales. There is a medication policy and procedure in place and the qualified nursing staff are responsible for the receipt, storage and administration of medication. The system and facilities were inspected and gaps were found in the medication administration records. Where service users are prescribed Digoxin the qualified nurses are to take a pulse reading and depending on the outcome of that reading will either administer the prescribed dose or omit the medication on that occasion. A number of the nursing staff record their findings of the pulse reading on the medication administration sheet but others do not. Arrangements need to be made to make sure that the recording procedure is consistent and that there is accurate information available when service users medication and conditions are being reviewed by their general practitioners. There is a medication monitoring system in place and the records showed that that gaps had been identified in the medication administration records but there was no information about what action had been taken to address this matter. Leeming Garth DS0000028033.V264749.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 and 15. Service users keep contact with family and friends and they have opportunities to take part in a range of activities. They have a choice of food from a varied menu. EVIDENCE: There were a number of visitors in the home at the time of the inspection and one of the service users told me that visitors are welcomed in the home. There was a lot of interaction between the staff and the service users spoken with said the staff were kind and gave them the support and assistance they needed. Staff were observed serving lunch well and assisting service users where needed and the service users were complimentary about the food. The home are advertising for a member of staff to take responsibility for organising activities in the meantime a member of the existing staff team has taken on this role temporarily. A variety of activities are planned for the coming festive season. Leeming Garth DS0000028033.V264749.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): 16 and 18. The home has a relevant complaints policy and procedure and all complaints are taken seriously. Staff would benefit from abuse awareness training. EVIDENCE: The details of how to make a complaint against the service are available in the service user guide and in the home. All complaints are dealt with according to the procedure and people are informed about the outcomes of the investigations. All the required checks are carried out on staff prior to their employment. Arrangements have not been made for staff to attend abuse awareness training. Leeming Garth DS0000028033.V264749.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, 20, 21, 22, 24, 25, 26. The service users are provided with a clean homely place to live in. There fire safety standards need to improve and sufficient bathing facilities must be provided. EVIDENCE: The home has both single and double bedrooms and all double bedrooms are used for single occupancy. Service users are encouraged to bring personal items with them and to personalise their rooms and many have photographs of their family around their rooms. There is a range of specialist equipment to assist them with their mobility and for pressure relief, including new profiling beds, pressure relieving mattress, cushions and hoists. There is level access to the home a passenger lift and a stair lift giving access to the upper floor. There is a large garden with views of the surrounding countryside.
Leeming Garth DS0000028033.V264749.R01.S.doc Version 5.0 Page 15 The home was warm, clean and there were no offensive odours and there are systems in place for routine maintenance of the building. The required safety certificates were in place including a current insurance certificate. Work has commenced to install a suitable weighing scales and replacement radiator guards. A number of the fire doors were held in the open position by the use of wedges and some bedroom doors had been fitted with door guards. There was a fire risk assessment in place, which stated that all fire door would be kept closed. The door closures had been fitted without consultation with the fire safety department and without being risk assessed. The recommendation made following the previous fire safety inspection was that wedges should be used to keep fire doors open. An immediate requirement was issued at the unannounced inspection of the 8th June 2005 requiring that door wedges must be removed and not used as a means of holding fire doors open. Arrangements were made for the fire safety officer to visit the home, to inspect the fire safety arrangements and to give advise on the use of door closures. During the course of the inspection it was identified that there are insufficient numbers of usable bathrooms for the number of service users accommodated. Work was ongoing to refurbish one of the bathrooms. Leeming Garth DS0000028033.V264749.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 and 30. The number of staff on duty were sufficient to meet the needs of the service users. EVIDENCE: The home employs qualified nursing staff, care staff, domestic and catering staff and admin staff in sufficient numbers to meet the needs of the service users. The qualified nursing staff have the relevant nursing qualification and attend regular internal and external training courses to up date their practice. All staff have a training portfolio and a number of care staff have achieved or are working towards NVQ Level 2. All staff have a period of induction and attend statutory training, which includes, moving and handling, fire safety, infection control, food handling. All staff are supervised on a regular basis. A number of the staff records were inspected and the required records were in place, which included a current CRB and POVA check. There is no time allocated in the shift pattern for all staff to have meet together to discuss the conditions of the service users or the activity in the home. The qualified nurses meet each shift to discuss matters concerning the service users and then make arrangements to pass this information onto the care staff. Arrangements need to be made for staff to attend abuse awareness training and a fire training refresher course.
Leeming Garth DS0000028033.V264749.R01.S.doc Version 5.0 Page 17 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): 31,33,35,36,37 and 38. The service users benefit from a well managed home but changes need to be made to make sure they are safe at all times. EVIDENCE: The registered manager is a qualified nurse and is experienced in managing a service for people who need nursing care. A number of the service users are supported by the staff with the management of their personal finances and the arrangements that are in place for this support and for the safekeeping of money and valuables were satisfactory and service users have access to their monies at all times. The required records policies and procedures were in place and found to be in good order and up to date and available to the staff. A representative of the proprietor visits the home as required and also as part of the company’s quality monitoring system.
Leeming Garth DS0000028033.V264749.R01.S.doc Version 5.0 Page 18 The reports that were available for inspection were not very informative about what areas of the home had been monitored. The practice in the home has been to wedge fire doors open. This should have been identified and addressed at the time of the visit. The home has a health and safety policy and procedure in place and all staff undertake health and safety training. Leeming Garth DS0000028033.V264749.R01.S.doc Version 5.0 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 3 3 3 X 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 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 1 17 X 18 2 1 1 1 1 X 1 1 1 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 3 1 Leeming Garth DS0000028033.V264749.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP9 OP19 Regulation 13(2) 23(4) Requirement The registered person is required to keep accurate medication administration records. The registered person is required to take adequate precautions against the risk of fire and for reviewing the fire safety precautions. (This requirement remains outstanding from the previous inspection.) The registered person is required to provide sufficient usable bathing facilities for the number of service users accommodated. (This requirement remains outstanding from the previous inspection.) Timescale for action 15/12/05 15/12/05 3. OP21 23(j) 30/03/05 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 OP18 Good Practice Recommendations It is recommended that arrangements be made for staff to attend abuse awareness training.
DS0000028033.V264749.R01.S.doc Version 5.0 Page 21 Leeming Garth Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Leeming Garth DS0000028033.V264749.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!
