CARE HOMES FOR OLDER PEOPLE
Leeming Garth Leeming Bar Northallerton North Yorkshire DL7 9RT Lead Inspector
Ms Anne-Marie Foster Key Inspection 4th July 2006 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Leeming Garth DS0000028033.V302977.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. Leeming Garth DS0000028033.V302977.R01.S.doc Version 5.2 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 leeminggarth@schealthcare.co.uk Southern Cross Home Properties Limited **Position vacant** 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.V302977.R01.S.doc Version 5.2 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. 22/11/2005 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 spread over two floors and there is stair lift and a passenger lift, giving access to the upper floor, there are two areas of the home, the manor and the court. The home is set in extensive grounds and there is ample car parking facilities for visitors and staff. Southern Cross Home Properties Limited owns the home. Fees range - between£317 and £631 per week – this information was current as at 24/5/2006 Leeming Garth DS0000028033.V302977.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced site visit took place on July 4th 2006.the site visit took 5 hours to complete. Information was also gathered prior to the visit from a preinspection questionnaire, 2 service user surveys and 2 GP surveys, surveys were also sent to 5 relatives of service users. A tour of the home was made including the bedrooms and communal areas, and the new manager was available on the day to assist the inspector. Service users were spoken with, along with nursing staff, care staff and ancillary staff. A selection of the homes records were inspected including service users care plans, staff files and maintenance records. Observations were made of the staff during their interaction with the service users. What the service does well: What has improved since the last inspection?
The staff are maintaining accurate medication records, including the good practice of recording the pulse of the service users taking Digoxin, this safe medication system will promote the safety of the service users. The home has installed sound activated fire door closures to bedrooms where the service user like to keep the door open, these work well during fire drills and will protect the service user in the event of a fire. Leeming Garth DS0000028033.V302977.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Leeming Garth DS0000028033.V302977.R01.S.doc Version 5.2 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 Leeming Garth DS0000028033.V302977.R01.S.doc Version 5.2 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 and 6 Quality in this outcome area is good. Service users do not move into the home unless their needs can be met; however the information given to service users needs to be updated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Pre admission assessments are carried out before a service user moves in to the home, so that the staff at the home can judge whether or not they can provide the necessary care, the information is recorded and links into the care plans - which were inspected and found to be satisfactory, this process ensures that no service user moves in to the home unless their needs can be met. One service user that had been staying for intermediate care confirmed that his needs were assessed and met, this helps to maximise the service user’s independence in order to return home. The new statement of purpose and service user guide is still at a draft stage; they need to be completed so that information packs can be given to prospective service users. Leeming Garth DS0000028033.V302977.R01.S.doc Version 5.2 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): 7,8,9 and 10 Quality in this outcome area is adequate. Service users needs are generally well met, though improvements should be made to ensure that service users are treated with respect, and that their right to privacy and dignity is upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The health, personal, and social care needs are well set out in good plans of care, these are reviewed regularly, enabling the staff to understand what care duties they need to give. Care plans contained good information relevant to the heat wave that was occurring at the time of the site visit, this would be helpful for staff in order to prevent or recognise the symptoms of heat exhaustion. The practice of involving residents and /or their families in the development and review of the care plan is variable; two residents that were able to be involved had not been asked about their plan of care or if they would like to be involved, this is a missed opportunity to develop a comprehensive, and meaningful plan. The medication system in the home was inspected, staff are now recording the service user’s pulse to show that it has been taken and is acceptable prior to the administration of Digoxin - this was
Leeming Garth DS0000028033.V302977.R01.S.doc Version 5.2 Page 10 highlighted as a problem at the last inspection, this good practice should continue in order to maintain a safe system. Staff need to be instructed during induction on how to treat service users with respect at all times, and whilst the staff were seen to be addressing the service users respectfully, one carer was seen during the site visit to ‘talk over’ the service users and also talk as if the service users were not present, this practice compromises the service users rights to dignity and privacy. One service user commented that she was disappointed when staff did not introduce themselves, or listen to what she had to say and this poor practice means that service users are not always treated with respect. Leeming Garth DS0000028033.V302977.R01.S.doc Version 5.2 Page 11 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,and 15 Quality in this outcome area is adequate. Service users have little opportunity to take part in organised activities, but enjoy their contact with family and friends as they wish. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is without an activities organiser; there is a lack of stimulation and two service users report, “ there is little to do”. Whilst the home is trying to recruit for the post, the job of organising activities is left to the care staff and so events are not timetabled, this means the lifestyle of the service user does not meet their social, cultural recreational needs. Service users can receive visitors when they please and the visitors are welcomed to the home, meaning that community contact can be maintained. There are several communal areas in which to sit and so the service user can choose a variety of seating areas. The administrator for the home also runs a small tuck shop, enabling service users an opportunity to exercise further some choices in their daily life. The lunchtime meal and the menu were observed, the menu was varied with several choices on offer, but whilst the lunch looked appetising, the day of the site visit was extremely hot weather, and the two choices for lunch were
Leeming Garth DS0000028033.V302977.R01.S.doc Version 5.2 Page 12 ‘heavy’ options: toad in the hole or pork casserole, and so several service users did not enjoy the meal. Downstairs in the court’s combined lounge/dining area the TV remains on and turned up very loud throughout the meal, when asked if the service users wanted it on the carer replied, “yes it doesn’t seem to bother them”, this should be determined by asking each service user, as it does mean that the lunchtime routine is no different to the usual daily routine in this dining lounge, and offers little opportunity for any conversations to take place. Leeming Garth DS0000028033.V302977.R01.S.doc Version 5.2 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 Quality in this outcome area is adequate. The home has a clear complaints policy, and service users are protected from abuse, however a more robust training system needs to be implemented to reinforce abuse awareness. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear complaints policy, several staff members and two service users told the inspector that they did know how to make a complaint, also two service users replied to the inspector via a survey which family members helped them to fill in, and these confirmed that the service user would feel able to complain if necessary and so could be confident that their complaint would be listened to, taken seriously and acted upon. Staff spoken to included three care staff were aware of the procedures for reporting adult abuse, however there is not a robust training system in place to ensure regular updates take place, and the manager could not find the latest North Yorkshire Adult Protection Policy, this could lead to a compromise in the system and leave service users vulnerable. Leeming Garth DS0000028033.V302977.R01.S.doc Version 5.2 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): 19,21,24,25 and 26 Quality in this outcome area is poor. Service users live in a clean tidy home, however improvements must be made to ensure the comfort of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Whilst the home is clean and tidy and on the whole well decorated, there are areas that need to improve. There are many bathrooms in the home; however only three are suitably adapted for use, and one of these three has poor flooring. Since the last inspection when a requirement was left because of insufficient bathing facilities, the large bathroom (no 8) upstairs started to undergo improvements including a new raised bath with overhead hoist, this work however came to a halt in February and nothing has been done to the room since, this is frustrating to staff and service users as it means there are still not enough bathing areas and the needs of the service user are not met. Other bathrooms are of an ordinary domestic type and are now used as storage areas; service users cannot therefore access them. Service users on
Leeming Garth DS0000028033.V302977.R01.S.doc Version 5.2 Page 15 the whole have good sized rooms with pleasant views and fresh décor, however one service user has had to move out of her room as part of the ceiling fell down after a heavy rain storm. The roof has since been repaired but the ceiling has not and the plaster remains on the floor to the room with plaster dust covering the service users possessions, this room has been like this since February and needs cleaning and repairing, in order that the service user can live in her own room with possessions around her. The radiator covers are gradually being replaced, this was a problem identified at a previous inspection in July 2005, however the work has still not been completed, the old mesh radiator covers are so close to the radiator there is no protection offered and this poses a risk to the service user. Sound actuated fire door closures have now been fitted, and are working to bedroom doors, this was a problem highlighted at the last inspection. Laundry facilities were inspected and found to be satisfactory and staff were observed handling laundry in a proper manner meaning the home is using good practice to prevent the control of infection. The water temperatures in the home were tested and found to be satisfactory meaning that service users are protected against risks of scalding. The kitchen was inspected whilst the lunchtime meal was at the final stage of preparation and the kitchen was found to be very clean and organised. One problem in the kitchen is lack of fridge and freezer facilities, because of broken equipment the chef has to walk down the corridor which residents use, to access a fridge and freezer in an outside store area, this could compromise the residents access to the corridor and presents a potential food hygiene hazard. Leeming Garth DS0000028033.V302977.R01.S.doc Version 5.2 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): 27,28,29 and 30 Quality in this outcome area is adequate. Service users needs are met by the numbers of staff, but further training would increase the skill mix of staff and enable them to become more competent to do their jobs. This judgement was made using available evidence including a visit to this service. EVIDENCE: The staff rota demonstrates good numbers of staff including three registered or enrolled nurses on duty per day, 5 senior carer staff have their NVQ2 certificate in care and 5 care staff are about to complete their NVQ2 certificate, this will be of benefit to the service users. Whilst recruitment procedures appear robust and files show a good application form, employment audit trail and two good written references; of the six staff files inspected no Criminal Record Bureau (CRB) form could be seen except for old CRB forms - this is because they are held at head office. The manager should give the inspector the opportunity to view the forms of current employees on the day of the inspection, and this practice of not having the CRB form in the home could compromise the otherwise good recruitment procedure and the protection of the service users. There was no plan of staff training available and the manager was unsure of what training staff had undergone, staff were sure that they did not receive the minimum three paid days training per year and usually the qualified nurses used their own (unpaid) time to attend courses. Staff files did show an induction training programme, but no reference was made to privacy and dignity training, meaning that the workforce would not be working to fulfil the aims of the home and meeting the changing needs of service users.
Leeming Garth DS0000028033.V302977.R01.S.doc Version 5.2 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 and 38 Quality in this outcome area is adequate. Service users live in a home with a new manager who is resident focused and who has their best interests at heart, but some health and safety issues need to be addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The new manager had just come in to post the day before this site visit, and has been working as deputy matron/manager for the past five and a half years and so is very familiar with the running of the home. The home uses a quality assurance system based around a questionnaire for service users, their relatives and friends, this needs to continue and the new manager must collate the information in order to judge how the service is performing. To be able to measure its success or address any problem areas this questionnaire should be reviewed and extend to families, friends and other stakeholders. A
Leeming Garth DS0000028033.V302977.R01.S.doc Version 5.2 Page 18 questionnaire related to menu choices and food preferences would be useful to service users as two who commented that they didn’t always like the food did not want to say this to the staff and might prefer to use another method of expressing their views, also the manager does carry out a ‘surgery’ where service users and families can access her time. These questionnaires or surveys, plus manager’s surgery help to ensure that the home is run in the best interests of its residents. Service users personal finances are well managed by the homes administrator and monies are kept in a safe, this system was inspected and was found to be robust and so the service users are protected from financial abuse. The manager was able to demonstrate the policies for ensuring safe working practices although an ongoing training programme must be developed which is easy and clear to see; staff files inspected contained evidence of induction training but no foundation training or refresher training which is necessary to protect the health safety and welfare of staff and service users. The home employs a dedicated maintenance man and the maintenance records inspected were found to be satisfactory, also he is responsible for fire safety training (he is a retired fire officer) and so the staff are well informed and they and the service users are protected by a safe system. The manager is responsible for the maintenance of a safe environment and currently the chef does not have access to enough fridge freezer space due to broken down equipment this means that health and safety is compromised in the kitchen area. Leeming Garth DS0000028033.V302977.R01.S.doc Version 5.2 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 2 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 X 1 X X 2 1 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 X X 1 Leeming Garth DS0000028033.V302977.R01.S.doc Version 5.2 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 Standard OP18 Regulation 18 Requirement The responsible individual is required to provide training for all staff to raise their awareness of abuse of vulnerable adults and the manager must have the City of York and North Yorkshire Adult Protection Committee document “No secrets” in the home and cascade this information to all staff. (This requirement is an outstanding recommendation from the last 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 two inspections.) The responsible individual needs to ensure that dignity, privacy and respect are topics covered during induction and foundation training, and that all staff treat all service users with respect at all times.
DS0000028033.V302977.R01.S.doc Timescale for action 31/08/06 2 OP21 23(j) 31/08/06 3 OP10 18 01/08/06 Leeming Garth Version 5.2 Page 21 4 OP19 23 OP25 5 OP29 19 6 OP33 24 7 OP38 19 The responsible individual should ensure that the home is suitable for its purpose by ensuring that the bathroom refurbishment continues, and that the work of fitting the new radiator covers continues. The responsible individual must ensure that copies of the copies of the Criminal Bureau Check form of employees are available in the home for The Commission for Social Care Inspection. The manager should redevelop the quality assurance system so that the home is run in the best interests of the service users. The manager must develop the training programme to encompass health and safety training. The responsible individual should address the lack of fridge and freezer in the kitchen situation as soon as possible. 31/08/06 01/08/06 31/08/06 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP1 OP12 OP15 Good Practice Recommendations The responsible individual must ensure the statement of purpose and service user guide are up to date and available to prospective service users. The manager should appoint an activities organiser as soon as possible so that organised activities could take place. The responsible individual should review the use of the dining rooms to check that the mealtime experiences are enjoyable and that the service users are eating in a congenial setting.
DS0000028033.V302977.R01.S.doc Version 5.2 Page 22 Leeming Garth 4 5 6 7 OP24 OP28 OP30 OP31 The responsible individual should ensure that repairs to one service users bedroom continue, so that she is able to move back in as soon as possible The home should have a minimum of 50 trained members of the care staff (NVQ 2 level or above). It is recommended that the responsible individual develops a clear training programme that offers staff at least three paid training days per year. The manager needs to apply to become registered with The Commission for Social Care Inspection as soon as possible. Leeming Garth DS0000028033.V302977.R01.S.doc Version 5.2 Page 23 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
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