CARE HOMES FOR OLDER PEOPLE
Liverpool Road (23) 23 Liverpool Road Thornton Heath Croydon Surrey CR7 7RE Lead Inspector
Claire Taylor Unannounced Inspection 3rd February 2006 10:00a 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 Liverpool Road (23) DS0000028100.V281297.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Liverpool Road (23) DS0000028100.V281297.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Liverpool Road (23) Address 23 Liverpool Road Thornton Heath Croydon Surrey CR7 7RE 020 8653 5280 020 8653 5280 no email 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) Mrs Daphne Mahoney Mrs Daphne Mahoney Care Home 3 Category(ies) of Old age, not falling within any other category registration, with number (3) of places Liverpool Road (23) DS0000028100.V281297.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th October 2005 Brief Description of the Service: Beatitudes, 23 Liverpool Road, is situated in a quiet residential area in Thornton Heath. It is near the shopping centre and well placed for transport links to local amenities and nearby Croydon town. Beatitudes is registered to provide care and accommodation for three older people and operates very much as a small family type home. Service users each have a single bedroom and adequate shared communal space, including a lounge and dining area. There are two toilets and one bathroom. There is a small rear garden with lawn and paved areas. Liverpool Road (23) DS0000028100.V281297.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the home’s second routine unannounced inspection for the year and lasted three hours. Inspection time was spent examining records, talking to the residents and meeting with the manager/ owner Mrs Mahoney. The same three residents continue to live at Beatitudes and the manager reported that there have been no significant changes since the last inspection. The focus of this visit was to check the home’s progress to meet requirements from the previous inspection and the core standards not assessed at that visit. The residents and Mrs Mahoney are thanked for their time and contribution to this inspection. What the service does well: What has improved since the last inspection?
The manager has taken action to address all the previous areas identified for improvement for which she is commended. Risk plans for residents have been reviewed to reflect changing needs and ensure that staff have up to date information on how to support them. Some further recreational activities have been introduced such as art and craft activities and the manager has purchased a larger television for the residents. The premises have been reassessed by an occupational therapist to ensure that residents have the necessary aids and adaptations to meet their needs. Following this, one resident has been provided with a new recliner chair. An electronic keypad access system has been fitted to the front door meaning that residents’ safety is further maximised and fire regulations are complied with. The manager/ owner and staff continue to undergo further training in key areas to keep their knowledge and skills up to date. Courses have included fire safety, infection
Liverpool Road (23) DS0000028100.V281297.R01.S.doc Version 5.1 Page 6 control and adult protection. Recruitment practices have been improved upon to protect the residents against the employment of unsuitable staff. Residents completed satisfaction questionnaires about food provision and menus have been revised accordingly. 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. Liverpool Road (23) DS0000028100.V281297.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Liverpool Road (23) DS0000028100.V281297.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this home as it does not provide intermediate care. The home carries out pre-admission assessments, ensuring that residents are appropriately placed and therefore receive the care that meets their needs. EVIDENCE: There have been no new admissions to Beatitudes since the last inspection and the three same residents reside there. The manager has devised a preadmission assessment tool for the home and assessments were completed appropriately for each resident when they all first moved to the home. The assessments provide staff with the necessary information about a person’s holistic care needs and how they should be supported. Each individual also has a needs assessment undertaken by a care manager from the placing authority. Annual meetings are organised by each resident’s care manager to ensure that assessed needs continue to be met and the home also carries out a needs review every six months. Liverpool Road (23) DS0000028100.V281297.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 10 Residents’ care and health needs are identified and reviewed regularly so that they continue to be met. Good health is maximised by ensuring that individuals have access to relevant health care services to meet their assessed needs. Residents spoken with were happy that they were treated with respect and that their privacy was respected as much as was possible. Standard 9 was assessed as met at the October 2005 inspection. EVIDENCE: Generated from the needs assessments, residents have a detailed written care plan in place for staff to follow to cater for their individual needs. Records showed that care plans continue to be reviewed on a monthly basis and any changing needs are identified and addressed. Examples included a revised support plan for one resident with the deteriorating health condition, Parkinson’s disease. I.e. changing needs regarding the person’s mobility were identified and risk assessments reviewed accordingly. Another resident with visual impairment had new plans of care related to improving their time awareness and socialisation. The resident had been provided with a larger timepiece to assist them. The manager explained that she was due to contact the voluntary association for the blind to find out about a local social club that may be of interest to the resident.
Liverpool Road (23) DS0000028100.V281297.R01.S.doc Version 5.1 Page 10 Residents are in frequent contact with General Practitioners and other health care professionals as required. I.e. chiropody, optician, dental and one resident attends regular appointments with a neurosurgeon for his Parkinson’s disease. In addition, a Consultant Psychiatrist monitors the care and psychological health needs to ensure that residents continue receiving the correct treatment or medication. Residents are weighed on a monthly basis and appropriate records maintained. In addition, each person’s nutritional needs are clearly outlined within the care plan. Residents are encouraged to maximise their mobility through walking and other gentle exercises. Falls are minimised through the use of risk assessments and individual guidelines and these had both been reviewed as required at the previous inspection. Personal care and routine health monitoring charts were in place for each resident and being regularly completed. Provision is made to ensure that residents’ right to privacy is respected and individuals indicated they are treated with respect and kindness by staff. Care records indicated that residents are consulted about the care that they receive. Liverpool Road (23) DS0000028100.V281297.R01.S.doc Version 5.1 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 The home has improved upon the range of activities offered to provide more stimulation and enhance the lives of its residents. Systems are in place for supporting residents to exercise choice and control over their lives as far as possible. Meals are nutritiously balanced and offer a healthy and varied diet for the people who live there. EVIDENCE: The residents continue to attend a local church day centre for three to four days a week where activities such as games, exercise and sing-a long sessions and quizzes are provided. Recreational activities available within the home include television, radio, gentle exercise sessions, newspapers/ magazines, and board games. As previously required the manager has made efforts to provide further stimulating activities for the residents. Art and craft activities have been introduced. Records of residents’ participation in community activities and outings are kept although it is suggested that the staff also note down the home activities that people take part in. Recent events had included shopping trips in the local town centre and some local church functions such as parties. Residents’ religious needs and beliefs are catered for and one person said that the home arranges transport for them to attend church every week. A larger television has been purchased for the residents since the last visit. Residents are provided with three meals a day as well as regular snacks and drinks. A
Liverpool Road (23) DS0000028100.V281297.R01.S.doc Version 5.1 Page 12 selection of fruit was available in the dining area for residents to help themselves. The menu, supplemented with photos, is made available to residents and offers a varied and nutritious range of food. Residents spoke positively in respect of the food provided at the home and had recently been offered a satisfaction questionnaire to establish their personal preferences. These all gave complimentary feedback. The previous requirement regarding residents’ food choices had therefore been addressed. The residents are supported to maintain social contacts with family and friends as they so choose. Liverpool Road (23) DS0000028100.V281297.R01.S.doc Version 5.1 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 Arrangements for complaints and protection from abuse are generally well managed and ensure that residents feel listened to and safe. EVIDENCE: The home has a policy for dealing with complaints and copies are available to residents, relatives and other parties. Information is made available in the Service User Guide about how a compliant, concern or suggestion should be made, and how this will be handled. Residents spoken to have confidence that their concerns would be dealt with by the manager. A record book is kept and no complaints have been made either to the home or to the Commission for Social Care Inspection since the last inspection or within the last twelve months. As previously recommended, the complaint log form had been revised for better clarity i.e. the date; nature of complaint; outcome and action taken specified. The home has procedures in place for responding to suspicion or evidence of abuse, including whistle blowing and a copy of the London Borough of Croydon’s adult protection guidelines. The manager/ owner and most of the small staff team have attended an adult protection training course. Adult Protection issues and abuse awareness are also included within the induction process for new staff. The home also has a video on elder abuse available for both new and current employees to access. Liverpool Road (23) DS0000028100.V281297.R01.S.doc Version 5.1 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, 22 and 26 Beatitudes is clean, hygienic and comfortably furnished and residents live in homely and pleasant surroundings. Appropriate aids and adaptations are in place to promote a safe environment and meet residents’ assessed needs. EVIDENCE: The home is an ordinary family house designed to accommodate older people requiring personal care and its layout meets the current needs of the residents. As previously required and due to the changed mobility needs of one resident, a second premises assessment has been carried out by a qualified Occupational therapist. The report confirmed that the premises and facilities were satisfactory and as recommended, this resident has now been provided with a new recliner chair which has clearly given the person more independence. The resident was able to operate the chair and said it was very comfortable. Other aids and equipment are in place such as grab rails, walking frames as well as white markings on steps. One resident who has a visual impairment confirmed that they were able to get around the house with little support and also felt confident in their surroundings. Good standards of hygiene practice are well observed and the home once again, appeared clean and free from odour.
Liverpool Road (23) DS0000028100.V281297.R01.S.doc Version 5.1 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 and 30 Recruitment practices have been improved upon to protect the residents against the employment of unsuitable staff. There is a small stable staff team who have been provided with appropriate training to meet the residents’ needs. Standards 27 and 28 were assessed as met at the October 2005 inspection. EVIDENCE: All staff files were checked and show that the manager ensures safe practices when recruiting new staff with completion of an induction-training programme for each staff member. References and other necessary checks had been completed, including a CRB check, proof of identity and recent photograph. As previously required, the manager had applied for new CRB disclosures for two staff since their previous ones were undertaken by the previous employers. Records showed that staff have received appropriate specialist training that is in meeting with the residents’ needs. I.e. diabetes. Other training certificates included topics such as awareness of visual impairment, nutrition course and dementia awareness. Key health and safety training in basic food hygiene; moving and handling; infection control and first aid had also been achieved. Each staff has a development assessment and profile that shows what courses they have attended and any planned training needs. There has been recent training in fire safety and adult protection since the last inspection. Liverpool Road (23) DS0000028100.V281297.R01.S.doc Version 5.1 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): 31, 35 and 38 The manager/ owner has relevant qualifications and continues to run the home in the best interests of the residents. The home’s financial procedures are thorough and protect the interests of the residents. Improvements have been made to further promote and protect the health, safety and welfare of people living and working in the home. Standard 33 was assessed as met at the October 2005 inspection. EVIDENCE: Discussions and observation showed that the manager/ owner is clearly familiar with the needs of the three residents and the care of older people. Mrs Mahoney is a registered nurse and has completed a diploma in management studies. Residents spoke positively about the manager. Certificates were in place and showed that Mrs Mahoney has attended periodic training alongside the staff to keep her knowledge and skills up to date.
Liverpool Road (23) DS0000028100.V281297.R01.S.doc Version 5.1 Page 17 The manager explained that one resident is subject to Power of Attorney and the other residents have family acting on their behalf. Two individuals handle their own affairs and keep their own purse / wallet of personal monies. Records of transactions concerning the other resident were being maintained appropriately. Previous inspection requirements (October 2005) had been addressed. Staff have undergone fire safety training and an electronic keypad system has been fitted to the front door as a replacement for the previous use of a key. In addition, a policy and risk assessment has been put in place regarding the locking and security of the front door. The manager is required however to ensure that the home’s fire policy reflects the new security arrangements in the event of a fire evacuation. Fire drills are appropriately organised and fire alarms and equipment checked at regular intervals. Accidents and incidents are documented appropriately. Other servicing and maintenance records for the home were checked at the last inspection and up to date. Liverpool Road (23) DS0000028100.V281297.R01.S.doc Version 5.1 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 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 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 2 Liverpool Road (23) DS0000028100.V281297.R01.S.doc Version 5.1 Page 19 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 OP38 Regulation 23 Timescale for action The fire evacuation procedure for 31/03/06 the home must be revised following the installation of the new keypad entry system. A copy must be displayed in the home. Requirement 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 OP13 Good Practice Recommendations The home should keep records of all social and recreational activities that residents participate in i.e. to include those undertaken in the home. Liverpool Road (23) DS0000028100.V281297.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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