CARE HOMES FOR OLDER PEOPLE
Loose Court Rushmead Drive Maidstone Kent ME15 9UD Lead Inspector
Lynnette Gajjar Unannounced 3 May 2005 09:25 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 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. Loose Court H56-H06 S23872 Loose Court V223026 030505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Loose Court Address Rushmead Drive Maidstone Kent ME165 9UD 01622 747406 01622 749948 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Jewel Homes Ltd Mrs Debra Carson CRH Care Home 39 Category(ies) of DE(E)Dementia-over 65 (39) registration, with number of places Loose Court H56-H06 S23872 Loose Court V223026 030505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Care is restricted to provide older person residential care to 7 persons not diagnosed with dementia Date of last inspection 15 December 2004 Brief Description of the Service: Loose Court was a domestic house until 1982, when it changed to a care home for the elderly. The house has had purpose built extensions. The accommodation comprises of two lounges and integral conservatory, library and dining area, with 39 bedrooms of both single (31) and twinned rooms (4). There is a lift to access the first floor bedrooms, as well as stairs for those more ambulant. The home has a small garden. The care home is currently registered as a residential care home for 39 Dementia- over 65 years. With a condition restricted to 7 persons who care is Older Person not falling into any other category. The home directors and manager have expressed and evidenced a high commitment to Service Users involvement any changes to the care home and to provide the support, environment and trained staff in order to meet the care needs of their residents The home is approximately 50 yards from the main Loose road where local bus services are available to the town centre of Maidstone approximately 4 miles away, where there are two main line railway stations. Loose Court H56-H06 S23872 Loose Court V223026 030505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the first in the year running from April 1st 2005 to March 31st 2006. The visit lasted from 09.25am until 13.45pm. The home currently has 39 residents and is running with no vacancies. The visit was spent talking directly with residents privately and collectively; four care staff, welfare officer and the registered manager. Due to the nature of the service, it is difficult to reliably incorporate accurate reflections of the service users in the report. Some judgements about quality of life and choices were taken from direct conversation with residents and observation followed by discussion with support staff and evidencing records held at the home. A tour of the premises was undertaken. What the service does well: What has improved since the last inspection?
The home continues with the refurbishment programme to provide a high standard of accommodation. Working closely with residents to ensure a good and personal standard of care. The introduction of sensory and snoozlem room has been a success and well received by residents. Ongoing development in dementia care and training of staff enhances their understanding of individual care needs and provides good care.
Loose Court H56-H06 S23872 Loose Court V223026 030505 Stage 4.doc Version 1.30 Page 6 Residents spoke today of feeling safe, expressed confidence in the care staff and manager to listen to them and “feel good” in themselves. They have good support and encouragement to explore and maintain contact with the local community and facilities. Further staff has completed or commenced their NVQ 2 in care, building on their experience and personal competencies in supporting older people with dementia care needs. 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. Loose Court H56-H06 S23872 Loose Court V223026 030505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Loose Court H56-H06 S23872 Loose Court V223026 030505 Stage 4.doc Version 1.30 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 standard(s) 1,2,3,4,5 The homes statement of purpose and service users guide offer clear information about the home, with support of the assessment process and visiting programme to enable residents and families to make an informed choice to move into the home. EVIDENCE: The homes statement of purpose has been updated since the last inspection offering moiré information about the admission process. Further development of understanding of dementia care for care staff has enabled this process to be simplified and welcoming. Residents and relatives spoken with detailed involvement in visiting the home, coming for afternoon tea and meeting staff and fellow residents prior to deciding to move in. Relatives spoken with highly praised the welfare officer and registered manager on their open and supportive roles at this time. The home does not provide intermediate care. Loose Court H56-H06 S23872 Loose Court V223026 030505 Stage 4.doc Version 1.30 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 standard(s) 7,8,10,11 Residents are treated with genuine respect and dignity by care staff. Individual health and social care needs are well supported. EVIDENCE: Care plan records seen were sufficiently up to date, detailed and contained clear information to support staff to meet the needs of the individuals. Residents spoken with had varying understanding of their care plans, some with no interest at all. Those spoken with were aware of paperwork needing to be done but were happy to leave that to the staff. Relatives confirmed their involvement with care staff in sharing information to help to develop their relatives care plan. Those spoken with felt fully involved and aware of their relatives care. It was noted that due care needs of residents changing to dementia care that more residents were wandering around the home, often disorientated, some wishing to go out for walks. Care staff were observed to be attentive to this, redirecting residents and arranging to escort them on short walks in the local vicinity in a sensitive manner. Care staff are mindful of how to prevent risk of falls, taking action to ensure safety for individual residents and this is clearly recorded. Loose Court H56-H06 S23872 Loose Court V223026 030505 Stage 4.doc Version 1.30 Page 10 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 standard(s) 12,13,14,15 Residents are encouraged to make choices about aspects of their daily lives, through support of a range of activities, services and health care in the home and local area. EVIDENCE: The home continues to have a close and effective working relationship with the local health professionals, supporting residents in their health care needs. Care plans seen recorded regular contact both at the home and their local practices/work place. Medication practice promotes good health care. This will be further enhanced with the plans to relocate the medication storage rooms allowing staff better access and storage facilities. Discussion took place with residents regarding the food at the home. The majority feed back was very positive with some minor personal preferences felt to be missed. These were discussed with the welfare officer and agreed easily addressed. Dining arrangements have been reviewed and altered to offer two sittings. The lunchtime period was observed to be well managed by care and catering staff with residents getting freshly served and hot food immediately they sat down. Residents in their rooms had hot food directly served too. Regular activities and entertainers are book to stimulate and encourage interaction with their peers. Personal wishes in the event of illness and death, although a difficult subject, are discussed sensitively with residents and families to ensure support and respect is maintained by care staff at such times.
Loose Court H56-H06 S23872 Loose Court V223026 030505 Stage 4.doc Version 1.30 Page 11 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 standard(s) 16,17,18 Residents and relatives feel confidant to raise concerns or complain, as they know they will be listened too and action taken to resolve them. Protection from abuse is promoted through staff training and understanding of the support and actions they may need to take. EVIDENCE: Residents spoken with knew who to talk to if they had a concern or wished to make a compliant, this included care, the manager, relatives and the inspector. Copies of the complaint procedure are available in the home. A resident discussed with confidence having received their electoral vote for the past elections and choosing to the postal vote. Fellow residents were not so interested in this. Staff who have been spoken with over a number of visits continue to evidence a good understanding of how to protect and prevent abuse. Reporting under local procedures. There are no current adult protection alerts relating to this home. Loose Court H56-H06 S23872 Loose Court V223026 030505 Stage 4.doc Version 1.30 Page 12 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 standard(s) 19,26 Residents live in a warm, nicely decorated, safe and clean home, which will be enhanced further with facilities being installed later this year. EVIDENCE: The home continues to be presented to good standard of hygiene and cleanliness. The development of the snoozalem room has proven to be successful. Also all communal rooms have water ioniser and aromatherapy units in use at all times giving of a subtle fresh smell. Security keypads have been installed to minimise the risk of residents entering stairwells, external doors and rooms holding equipment and chemicals. The registered manager detailed proposals to start the final part of building work to include a separate entrance to laundry room, larger medication storage room and additional toilets of the communal conservatory. The homes sluice room would benefit from more drying and storage racks. The garden has been completed and residents’ discussed looking forward to using this once the weather gets better. For further independence and to minimise the risk of falls, immediate exploration of the deep doorframe should be undertaken, particularly for those with limited mobility and reliant on Zimmer frames or wheelchairs.
Loose Court H56-H06 S23872 Loose Court V223026 030505 Stage 4.doc Version 1.30 Page 13 Loose Court H56-H06 S23872 Loose Court V223026 030505 Stage 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29, Residents benefit from the support of competent and skilled care staff, resulting in good morale and enthusiasm to improve their whole quality of life. EVIDENCE: Staff discussed attending a number of courses related to dementia care and health and safety core training increasing their personal knowledge and understanding of individual care needs and their responsibilities. The home continues to encourage and support care staff to completed their NVQ 2 and 3 in care. The home continues to have the same stable staff team. Shorter shifts allow for planned routine activities and appointments. Care staff spoken with and directly observed evidenced clear and good understanding of different individual care needs. Residents talked fondly of individual staff and their kindness. Some residents did not feel staff had time to sit and talk with them as much as they would like but understood ‘they were busy girls’. Staff were seen to support individuals respectfully but also with respectful familiarity resulting in some fun joking and banter from both parties. Loose Court H56-H06 S23872 Loose Court V223026 030505 Stage 4.doc Version 1.30 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32.33.37,38 Residents personal preferences, support and care needs are encouraged through the registered managers open leadership and the promotion of a safe home and working environment. EVIDENCE: The registered manager has worked with this service user group for a number of years and has completed NVQ 4 in Care and Management. Residents and staff expressed a high regard for their management approach to the home. Residents felt the registered manager was approachable and staff said they felt well supported. The registered manager and welfare office demonstrated through discussion, a very clear understanding if the needs of current residents and current issues. Monitoring health and safety in the home is to a good standard with the recent recruitment of handyperson / maintenance staff. Equipment is serviced as required to maintain a safe home and facilities. Risk assessments are completed for individuals and staff activities in the home and care duties. Staff evidenced a clear understanding of accident/incident
Loose Court H56-H06 S23872 Loose Court V223026 030505 Stage 4.doc Version 1.30 Page 16 recording and reporting under regulation 37 to the commission with monthly auditing. Loose Court H56-H06 S23872 Loose Court V223026 030505 Stage 4.doc Version 1.30 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 x x x 3 3 Loose Court H56-H06 S23872 Loose Court V223026 030505 Stage 4.doc Version 1.30 Page 18 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action 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 OP 9 Good Practice Recommendations It is recommended that a full review of the current medication storage be undertaken to comply with the Royal Pharmaceutical Guide on medicines in care homes June 2003. It is recommended the commission pharmacy inspectors prior to any work commencing view these plans for approval. Ongoing from the last inspection, this is proposed to address in the homes extension and refurbishment plans. It is recommended that high doorframes leading to the garden are risk assessed and the access made safe for residents It is strongly recommended that mobile screening be risk assessed for suitability, compared to fixed screening, particularly due to the proposed changing and more easily confused service user group. Ongoing from the last inspection, this is proposed to address in the homes extension and refurbishment plans. Laundry facilities located so that soiled articles, clothing, and infected linen are not carried through areas were food is stored, prepared, cooked, or eaten and do not intrude
H56-H06 S23872 Loose Court V223026 030505 Stage 4.doc Version 1.30 Page 19 2. 3. OP19 OP24 4. OP26 Loose Court 5. 6. 7. OP26 OP27 OP28 on Service Users. Ongoing from the last inspection, this is proposed to address in the homes extension and refurbishment plans Additional shelving and drying racks are installed in the homes sluice room, so pots are not stored on floor or top of machine It is recommended that staffing rosters hold the staff members full name A minimum ratio of care staff to be qualified to NVQ level 2 by 2005. Ongoing from the last inspection but evidence of a strong commitment by staff and the manager to work to achieve 50 as soon as possible. Loose Court H56-H06 S23872 Loose Court V223026 030505 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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