CARE HOMES FOR OLDER PEOPLE
Loran 106a Albert Avenue Anlaby Road Hull East Yorkshire HU3 6QU Lead Inspector
Sarah Urding Unannounced Inspection 25th January 2006 08:30 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 Loran DS0000000861.V257753.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. Loran DS0000000861.V257753.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Loran Address 106a Albert Avenue Anlaby Road Hull East Yorkshire HU3 6QU 01482 355996 01482 571230 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) Sandco 1(T/A Hill Care Services) Ms Brenda Johnson Care Home 35 Category(ies) of Dementia - over 65 years of age (35), Old age, registration, with number not falling within any other category (35) of places Loran DS0000000861.V257753.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To admit one male resident under 65 years in DE category. Date of last inspection 13th June 2005 Brief Description of the Service: The large old house and extension is behind the properties on Albert Avenue, Hull. It accommodates 35 older people who may have dementia, in single and double rooms (22 new singles have en-suite shower and toilet). There is a chair lift and a passenger lift, a large conservatory, a secure garden, car park, and local shops, health services and pubs near by. The home is on a bus route to the city centre. Loran DS0000000861.V257753.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over a period of six hours. The building was looked around and a number of records were inspected. Sixteen residents and four staff were spoken to. Two visitors to the home were also spoken to. What the service does well: What has improved since the last inspection? What they could do better:
The records kept on residents require improvement. Care plans are in place and informative in a general way. However more detail is required so that the home can be sure that consistent care is given. How oral health and foot care needs are to be met should be specified within the care plans. The records
Loran DS0000000861.V257753.R01.S.doc Version 5.1 Page 6 held on residents were untidy and not kept within the system designed by the home. Although the health care needs of residents are being met by the home, evidence of this in individual records was scant. The monthly weighing of residents where required had also lapsed. This practice must be improved upon. Some of the residents commented that they can be waiting a long time for the staff to assist them in their toileting. This must be given priority by the home. The medication system is accountable but some improvement in practice is required so that residents are consistently protected. Some residents said they were bored and there was not much to do. The home needs to look at the activities on offer in the home and ensure that the needs of residents are met in this area. The home does not evidence well that the requirements made by the fire and environmental health departments will be met. There is also no plan for the ongoing decoration and upkeep of the home. A maintenance plan should be produced incorporating planned work to be carried out. Recruitment practice in the home is not being safely carried out. CRB checks and two written references are not in place prior to staff staring work. This practice must improve with immediate effect as the safety of residents is compromised. 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. Loran DS0000000861.V257753.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 Loran DS0000000861.V257753.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): The assessment on admission assures residents that their needs will be fully met by the home EVIDENCE: Residents undergo a thorough assessment of needs prior to admission, which demonstrates that the home works in partnership with residents, their families and health professionals to glean full information about residents’ lives. The assessment covers all aspects of standard 3.3 and is completed in detail. The assessment links clearly to the care plan. Following recommendations made at the last inspection the manager writes to residents to assure them that their needs can be met by the home. Loran DS0000000861.V257753.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, 9 The care plans of residents are not detailed enough to ensure that all their health care needs will be met. EVIDENCE: Care plans are in place for all residents. However the detail in these plans does not provide staff with adequate information as to how needs are to be met. Oral health and foot care needs were not specified in detail. For example it was not clear from the care plans if residents required denture care and how this was to be carried out. This must be addressed. The health care needs of residents were being met by the home, which was confirmed by some residents. However the home does not consistently record when residents receive external health care. All appointments must be recorded so that there is evidence that services such as chiropody are accessed to residents on a regular basis. There was one area of practice that must be improved upon. The weighing of residents was not taking place as specified in their care plans. One resident had not been weighed for nearly a year and there was a marked difference in his weight from a year ago. The home must carry out actions specified in the care plans so that monitoring of
Loran DS0000000861.V257753.R01.S.doc Version 5.1 Page 10 health care needs takes place. Without this knowledge the changing needs of residents will go unnoticed and any resulting interventions will not take place. Residents said that they were looked after well by staff but a comment from one resident needs to be given priority. It was stated that there was often a delay in staff responding to requests for assistance in toileting. This is a basic need, which cannot be compromised. One resident looked after in the home is blind. In discussion with the manager, staff receive some induction training around how to work with this resident. However it would be good practice if staff were to receive more specific training around working with blind people so that staff are confident and informed about meeting all of the resident’s needs. The home’s medication system is safely managed and accountable. A pharmacist monitors this regularly, which is good practice. Medication is stored and administered appropriately however there were shortfalls in practice in the area of recording. On occasions there were gaps in the administration record so it was unclear whether medication had been given and the practice of keeping the key to the medication cupboard on a hook above the door must cease as it compromises safe storage arrangements. Controlled drugs were stored and administered appropriately. Loran DS0000000861.V257753.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, 15 Residents are not stimulated by the activities on offer in the home. Residents’ receive a well-balanced and varied diet. EVIDENCE: The home arranges activities for residents on a fortnightly basis where entertainers come into the home. The manager said that other day-to-day activities like bingo have been offered but residents do not wish to take part. In talking to residents a number said that there was not enough to do. One resident said “I’ve never been so bored in all my life”. Residents who have been in the home a long time said that since the numbers of residents had increased opportunity to experience trips out had decreased. They spoke positively about how it used to be. It is clear that existing arrangements for leisure pursuits is not meeting the needs of all residents. The home must address this. The religious needs of residents are being met by the home. During the course of inspection a service took place. The food provided by the home is well balanced and choice is given to residents. Dietary needs are met and evidenced well by the home. During the inspection lunch was observed and it looked appealing. Residents said that there is plenty to eat and drink throughout the day. The majority of residents spoken with said that they enjoyed the food. One resident said that the food
Loran DS0000000861.V257753.R01.S.doc Version 5.1 Page 12 was “A1”. Two residents spoken with said that they didn’t like the steak pie that they had recently had. They said there was no meat in it and the crust was too thick. This was fed back to the manager to address. Loran DS0000000861.V257753.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, 18 The arrangements for complaints and protection are handled well by the home and ensure that residents feel listened to and protected. EVIDENCE: The home has a clear complaints procedure in place. Residents spoken to said that they had no complaints about the home but felt confident to raise issues of concern if they arose. Complaints are recorded appropriately in a complaints log and addressed by the manager. There have been no complaints since the last inspection. The manager discussed whether to restart the “grumbles book”. This would be good practice and would evidence how comments like not liking the steak pie are addressed. The home has an appropriate policy in place for the protection of vulnerable adults. Staff spoken to were clear about reporting procedures should a resident make an allegation and around the indicators of abuse. Residents spoken to said that they felt safe when being looked after by staff. Not all staff spoken to understood the term whistleblowing although did talk about following correct procedures. It is recommended that training be revisited on a regular basis for all staff. Loran DS0000000861.V257753.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, 26 Residents are comfortable in the environment in which they live but the lack of evidence that highlighted maintenance issues will be addressed compromises their safety. EVIDENCE: Residents live in comfortable and well-decorated surroundings, which are clean and tidy. A programme of routine maintenance is not in place and some requirements have been made by the Fire and Environmental Health Departments. There was no evidence outlining how and when the required work was to be carried out. The home should develop a maintenance plan, which evidences this and any ongoing works as to the upkeep of the home. The premises is kept free from offensive odours and good hygiene practices were observed during the inspection. Systems are in place to control the spread of infection. Loran DS0000000861.V257753.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): 28, 29 The home’s practice in the recruitment of staff is not robust and does not offer protection to people living in the home. EVIDENCE: The home does not currently meet the standard relating to 50 of care staff being trained to NVQ level 2. There are however 2 staff with this qualification and a further three staff completing the course. The manager was positive that standards in this area will improve as additional funding has been received for those care staff who are over 25. The company is committed to achieving this standard and should do so if investment continues. Current recruitment practice in the home is poor and requires improvement. Two written references and CRB checks are not always in place prior to staff starting work, although where there is a delay in references the manager has recorded telephone conversations with referees. However this practice is not adequate enough to ensure that residents are protected. All staff employed in the home currently have a CRB check in place but it is not acceptable for this to be applied for after employment has commenced. In cases where the home is experiencing significant delays in the return of CRB checks, it is acceptable for POVA FIRST checks to be applied for. These must be in place prior to staff starting in the home if this is the case. The responsible person must ensure that staff are recruited as outlined in regulation. Failure to do so places residents at unnecessary risk from staff that may not be safe and may result in enforcement action being taken.
Loran DS0000000861.V257753.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, 37, 38 Residents live in a well managed home where their financial interests are safeguarded. However, some areas require attention in order to ensure that residents are safeguarded in all aspects of care. EVIDENCE: The home’s manager is experienced in managing a care home and staff feel well supported and informed to carry out their duties. The home’s manager started her NVQ level 4 in care and management but experienced difficulties in being able to complete this course due to circumstances beyond her control. She has had recent meetings with the college and is arranging to restart the qualification. This should take place within two months of the inspectors visit. Residents are protected by the financial procedures of the home. The home looks after money appropriately. Written records of all transactions are accurately maintained.
Loran DS0000000861.V257753.R01.S.doc Version 5.1 Page 17 Record keeping in the home requires improvement. As mentioned previously in this report, the records held on residents are untidy and lack consistency. Some health care appointments are not being recorded in residents’ files and must be under regulation 17, schedule 3. This must be addressed by the home. Generally the home operates in the best interests of the health and safety of residents and staff. All safety checks are carried out within the specified time frame and policies are in place for safe working practice. However some aspects of the environment require attention so that residents’ health and welfare is maintained. The grab rail in the downstairs corridor was not secure and could result in the fall of a resident. This must be addressed. The carpet in one residents room was rucked and a trip hazard. This must be repaired or replaced. The bath hoist cover in the downstairs bathroom was dirty and in need of cleaning or replacing. This must take place so that the risk of cross contamination is minimised. Loran DS0000000861.V257753.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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 X 28 2 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 3 X X 2 Loran DS0000000861.V257753.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 OP7 Regulation 12, 13 Requirement Timescale for action 01/03/06 2 OP8 3 OP9 4 OP29 5 OP37 6 OP38 Care plans of service users must identify how oral and foot care needs are to be met by the home. 12, 13 The registered manager must ensure that the health care needs of service users are met. service users must be weighed as specified within their care plans and residents requiring assistance with toileting must be promptly seen to. 12, 13 Medication must be safely stored and administered. The key to the medication cupboard must not be accessible to service users and administration records must be fully completed. 19 The registered manager must ensure that CRB checks and two written references are in place prior to staff starting work. 17 The registered manager must ensure that records for service users are consistently kept. Health care given to service users must be recorded. 12, 16, 23 The registered person must ensure that the health and safety
DS0000000861.V257753.R01.S.doc 25/01/06 25/01/06 25/01/06 01/03/06 01/03/06 Loran Version 5.1 Page 20 of service users is protected. The grab rail must be secured; The carpet in one service user’s room must be made safe; the bath hoist cover must be cleaned or replaced. 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 4 Refer to Standard OP8 OP12 OP16 OP19 Good Practice Recommendations Staff should receive specific training on working with blind people. The registered manager should review activities on offer in the home and meet the interests of all service users. The registered manager should reintroduce the “grumbles” book for service users. The registered person should develop a programme of routine maintenance including action and timescales for the required work of the fire and environmental health departments to be carried out. The registered provider should ensure 50 of care staff achieves NVQ level 2. The registered manager should enrol on NVQ Level 4 programme within two months of this inspection date. 5 6 OP28 OP31 Loran DS0000000861.V257753.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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