CARE HOMES FOR OLDER PEOPLE
Maurice House Callis Court Road Broadstairs CT10 3AH Lead Inspector
Clair Brown Unannounced Inspection 6th March 2006 13.30h 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 Maurice House DS0000037465.V282718.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. Maurice House DS0000037465.V282718.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Maurice House Address Callis Court Road Broadstairs CT10 3AH 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) 0207 9737200 The Royal British Legion Vacant Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47) of places Maurice House DS0000037465.V282718.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th March 2003 Brief Description of the Service: Maurice House is a large detached purpose built care home, which is set in accessible attractive grounds in a semi-rural location. Nearby towns and amenities are only a few minutes drive away. The Home is registered to provide nursing care and therefore employs a number of registered nurses. The Home has a hotel type atmosphere. The Home has a number of shaft lifts to access all levels of the Home. The grounds have had pathways built so that service users can access them and appreciate the views over the sea. Maurice House DS0000037465.V282718.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 announced inspection. The inspection was conducted by one inspector and the duration of the inspection was 3 hours on one day. The Home representative was the acting manager. Additional time was spent in planning the inspection and report writing. The inspectors spent time talking to 2 service users and 1 staff to gain their views. Documents and records were examined and service users files were case tracked. Since the last inspection the registered manager has left and the deputy manager is now acting manager. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
Maurice House DS0000037465.V282718.R01.S.doc Version 5.1 Page 6 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Maurice House DS0000037465.V282718.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 Maurice House DS0000037465.V282718.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): 1,2,3 The statement of purpose does not provide up to date information to enable prospective service users to make an informed decision. Pre-admission assessments are conducted with sufficient information gathered to enable the manager to make an informed decision. No progress has been made with the review of the contract. EVIDENCE: The statement of purpose has not been reviewed to reflect the recent changes to the organizational structure. The contract is a 20 plus page legal document, a requirement has been made since 2004, for the contract to be reviewed to make it user friendly, to date the Royal British Legion has not done this. A pre-admission assessment was read of a service user admitted recently this contained details about their medical history and personal needs as well as their individual likes and dislikes. Maurice House DS0000037465.V282718.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): 7,9 The home fails to produce care plans for all service users. The written medication policies & procedures do not reflect current practices. EVIDENCE: One service users file was case tracked. The service user had been admitted to the home 2 months earlier. There was a detailed pre-admission assessment conducted by the acting manager, there was a dependency assessment/score that identified a high needs score. However there was no formal care plan written. When the care staff were asked for the care plan they appeared disinterested and said it hasn’t been written. The medication policy and procedure has not been updated since the last inspection. The acting manager confirmed that she has written to the G.P.’s and instructed staff on what action to take to ensure that all medication has the full administration details prescribed on the label. Maurice House DS0000037465.V282718.R01.S.doc Version 5.1 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 the following standard(s): EVIDENCE: Maurice House DS0000037465.V282718.R01.S.doc Version 5.1 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 the following standard(s): Procedures are implemented to protect service users from abuse but these still need updating. EVIDENCE: The adult protection policy and procedure has not been properly reviewed and updated to ensure the information is in line with current practices and up to date. Maurice House DS0000037465.V282718.R01.S.doc Version 5.1 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 the following standard(s): EVIDENCE: Maurice House DS0000037465.V282718.R01.S.doc Version 5.1 Page 13 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): EVIDENCE: Maurice House DS0000037465.V282718.R01.S.doc Version 5.1 Page 14 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): 33,35,38 The quality of service provided is not regularly assessed and monitored. The service users financial accounts are recorded appropriately but the procedures for storing the money is inappropriate. EVIDENCE: The registered manager left shortly after the last inspection. The deputy manager is currently fulfilling the role as acting manager. She is eager to act upon the previously made requirements and has worked hard to meet some of these. The Royal British Legion has employed a person specifically for looking at quality assurance process. With these changes occurring the quality assurance programme has not been completed this year. The registered provider has not completed their required monthly visits. The service users financial records are clear and receipts are kept. However the money is not stored individually but stored all together in one locked tin and it is not possible identify each persons money, although this could be done from the individual accounts, the running total did not correspond with the amount of cash held. Care staff were seen to wearing large amounts of jewellery and
Maurice House DS0000037465.V282718.R01.S.doc Version 5.1 Page 15 some had facial piercings. These raised concerns relating to both service users and staff health & safety, as well as infection control. The head of the maintenance team now nominates someone to conduct the fire safety checks in his absence. Maurice House DS0000037465.V282718.R01.S.doc Version 5.1 Page 16 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 2 X X 2 Maurice House DS0000037465.V282718.R01.S.doc Version 5.1 Page 17 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 OP1 Regulation 4 5 sch 1 Requirement Required to update the statement of purpose to show the changes to the organisational structure. The Service Users terms and conditions must be reviewed to comply with the National Minimum Standards and Regulations and the Office of Fair Trading. (Previous timescale 21.12.04, 30.09.05, 31/03/06) The registered person must make an application for a variation to the homes registration for those service users admitted outside of the current registration. No service user is to be admitted that does not meet the homes current registration. Previous timescale: 30/01/06 To provide staff with the knowledge and skills to produce care plans and daily reports that are detailed and informative. Previous timescale: 31/03/06 All service users must have care plans written, despite the duration of their stay.
DS0000037465.V282718.R01.S.doc Timescale for action 31/07/06 2 OP2 5 31/07/06 3 OP4 12 14 18 14/04/06 4 OP7 12 13 14 15 16 17 31/03/06 5 OP7 12 13 14 15 16 17 17/03/06 Maurice House Version 5.1 Page 18 6 OP9OP18 12-17 20 23 sch 3 7 OP27 12 16 18 8 OP33 24 26 9 10 OP35 OP38 12 17 20 23 12 13 16 23 The adult protection and medication policy must be updated to provide details of current practices. Proper reviews must be conducted of the policies and procedures. Previous timescale: 31/03/06 The registered person must review staff working practices and procedures - relating to noncare duties performed and numbers of staff performing these at anyone time. Previous timescale: 31/03/06 The quality assurance programme must be conducted and completed this year. Registered provider monthly visits must be conducted and a report produced. Service users money must be held individually and not pooled together. All staff must adhere to health & safety policies and the uniform policy in relation to the wearing of jewellery and piercings. 31/07/06 31/07/06 31/07/06 31/03/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Maurice House DS0000037465.V282718.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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