CARE HOMES FOR OLDER PEOPLE
Monument House Resource Centre Wakefield Housing & Social Care The Circle Chequerfield Pontefract WF8 2AY Lead Inspector
Mr Tony Brindle Unannounced Inspection 9th February 2006 2:00 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 Monument House Resource Centre DS0000032906.V284286.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. Monument House Resource Centre DS0000032906.V284286.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Monument House Resource Centre Address Wakefield Housing & Social Care The Circle Chequerfield Pontefract WF8 2AY 01977 722830 01977 722833 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) Wakefield MDC Ms Gina Milne Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Monument House Resource Centre DS0000032906.V284286.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The care staffing hours are calculated by the provider using the Residential Forum staffing model and the number of full time equivalent staff appointed is in accordance with this calculation or otherwise as agreed in writing with the CSCI. 10th June 2005 Date of last inspection Brief Description of the Service: The overall aim of the Monument House Resource Centre is to provide a joined up service between health and social services, to promote faster recovery from illness, prevent unnecessary acute hospital admissions, support timely discharge and maximise independent living. Monument House offers a short stay in an environment, where the staff can work with residents to find out what care arrangements will suit them best. The manager, care staff and therapy staff encourage people to practice daily activities, to improve their confidence and ability to manage at home. These activities may include walking and exercise, domestic and daily living skills, personal care and hobbies and leisure activities. The servce aims to rebuild skills and confidence so that people can return home and continue to live independently. People usually stay for a period of no longer than six weeks. Monument House Resource Centre DS0000032906.V284286.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was a positive and enjoyable one with the inspector taking to service users, relatives and staff, looking at care plans and other daily records. The Commission would like to take the opportunity to thank the service users, the manager and support workers for their hospitality and patient cooperation throughout the inspection. There have been no additional or complaints visit to this home since the last inspection. There have been no changes to the Registered Persons registered with CSCI. What the service does well:
The work of the staff and the systems operated at the home make sure that residents only move into the home once assurances have been given that their assessed needs can be appropriately met. People’s rehabilitation and therapy needs are met by the work of the staff at the home. A reduction in the staffing levels and deployment of staff could jeopardize this, and its impact should be monitored closely. Staff develop with people a personal plan that details their needs and preferences, which sets out how they will be met, in a way that the individual finds acceptable. The systems and procedures followed by the staff at the home make sure that the healthcare needs of people are assessed and recorded, and opportunities are created to make sure these needs are met. The systems operated within the home promote and maintain people’s health and ensure that access to health care services to meet assessed needs. The current staffing numbers and skill mix of qualified/unqualified staff are appropriate to the assessed needs of the service users, the size, layout and purpose of the home. The safety of people at the home is promoted via a good mix of staff with difference experience, skills, abilities and qualifications. The manager operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. The manager ensures that there is a good staff training and development programme and ensures staff fulfill the aims of the home and meet the changing needs of service users. Monument House Resource Centre DS0000032906.V284286.R01.S.doc Version 5.1 Page 6 The manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. The health and safety of service users and staff are promoted and protected by satisfactory systems and procedures. 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. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Monument House Resource Centre DS0000032906.V284286.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 Monument House Resource Centre DS0000032906.V284286.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 and 6 The work of the staff and the systems operated at the home make sure that residents only move into the home once assurances have been given that their assessed needs can be appropriately met. People’s rehabilitation and therapy needs are met by the work of the staff at the home. A reduction in the staffing levels and deployment of staff could jeopardize this, and its impact should be monitored closely. EVIDENCE: Before coming to stay at the home, the needs of new people are assessed by way of a Community Care Assessment undertaken by a professional such as a social worker and the homes manager. The needs of new residents are recorded, and used to put together a plan of care for daily living. The manager explained that residents and their families (where appropriate) can have a look at their files. The staffing levels have been maintained and not cut as was the intention in the middle of last year. In fact, the unit now has better access to nursing staff based at the unit. However, there is the possibility that staffing levels may be cut in April, with a reduction in management and night staff.
Monument House Resource Centre DS0000032906.V284286.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, 10 Staff develop with people a personal plan that details their needs and preferences, which sets out how they will be met, in a way that the individual finds acceptable. The systems and procedures followed by the staff at the home make sure that the healthcare needs of people are assessed and recorded, and opportunities are created to make sure these needs are met. The systems operated within the home promote and maintain people’s health and ensure that access to health care services to meet assessed needs. EVIDENCE: People’s care plans contain detailed information about support and healthcare needs. The plans have a straightforward approach, concentrating on aspects of daily living. Restrictions are only placed on the residents following an appropriate risk assessment. Discussions with the staff showed that they have a good understanding of the support and care needs of the residents. A lot of good work has been undertaken by staff at the home to develop a more user friendly and appropriate care planning system. The staff are commended for this. Monument House Resource Centre DS0000032906.V284286.R01.S.doc Version 5.1 Page 10 Care staff confirmed that they are involved in maintaining the personal and oral hygiene people at the home, and that wherever possible, support the people’s own capacity for self-care. This was supported by comments from people at home such as, “the staff help me when I can’t do something myself.” People’s needs are assessed, by a person trained to do so, to make sure that those who are at risk of developing, pressure sores do not, and if it is needed, appropriate interventions are recorded in the plan of care. Equipment necessary for the promotion of tissue viability and prevention or treatment of pressure sores is available within the home. The manager and staff can access professional advice about the promotion of independence from the therapy and nursing staff based at the home, and aids and equipment are provided. Staff were observed to work in partnership with people, promoting independence, showing respect and maintaining people’s dignity. Visiting relatives commented on the professionalism of the staff team, and fact that they are always willing to help and go out of their way. Monument House Resource Centre DS0000032906.V284286.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): None of the core standards within this section were assessed at this occasion. A full assessment of the core standards will take place at the next inspection. EVIDENCE: Monument House Resource Centre DS0000032906.V284286.R01.S.doc Version 5.1 Page 12 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): None of the core standards within this section were assessed at this occasion. A full assessment of the core standards will take place at the next inspection. However, the Commission is aware that there have no complaints made against the home, and no adult protection referrals. Service users can expect the home to be run in a way that protects you from any avoidable risk or harm, including physical harm and infection. EVIDENCE: Monument House Resource Centre DS0000032906.V284286.R01.S.doc Version 5.1 Page 13 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): None of the core standards within this section were assessed at this occasion. A full assessment of the core standards will take place at the next inspection. EVIDENCE: Monument House Resource Centre DS0000032906.V284286.R01.S.doc Version 5.1 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 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 The current staffing numbers and skill mix of qualified/unqualified staff are appropriate to the assessed needs of the service users, the size, layout and purpose of the home. The safety of people at the home is promoted via a good mix of staff with difference experience, skills, abilities and qualifications. The manager operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. The manager ensures that there is a good staff training and development programme and ensures staff fulfill the aims of the home and meet the changing needs of service users. EVIDENCE: A recorded staff rota showing which staff are on duty was available .The ratios of care staff to service users is determined according to the assessed needs of people Additional staff are placed on duty at peak times of activity during the day. The current number of waking night staff is based on the numbers and needs of people staying at the home and takes consideration of the layout of the home. Domestic staff are employed in sufficient numbers to ensure that standards relating to food, meals and nutrition are fully met, and the home is maintained in a clean and hygienic state, free from dirt and unpleasant odours. The records show that two written references are obtained before appointing a member of staff, and any gaps in employment records are explored. New staff are confirmed in post only following completion of a satisfactory CRB check, and satisfactory check of the Protection of Children and Vulnerable Adults and NMC registers (where appropriate). New staff receive induction training, and
Monument House Resource Centre DS0000032906.V284286.R01.S.doc Version 5.1 Page 15 attend various mandatory and specialist training courses throughout the year. The training records show that the staff training and development programme makes sure that the staff meet the changing needs of service users. Staff commented that they receive a good training package based on their learning and development needs. Relatives commented that they were impressed that the staff received training and that it was a good thing, as it gave they confidence in the staff group. The service user who were spoken with did not comment on staff training issues. Two people did say that the staff always appear to be very busy with a lot to do, but do not perform any personal care or personal support in a rushed manner. Monument House Resource Centre DS0000032906.V284286.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): 38 The manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. The health and safety of service users and staff are promoted and protected by satisfactory systems and procedures. EVIDENCE: The manager makes sure that so far as is reasonably practicable the health, safety and welfare of service users and staff, by way of staff training, fire safety system testing, risk assessment and safety system monitoring. Monument House Resource Centre DS0000032906.V284286.R01.S.doc Version 5.1 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 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 2 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 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Monument House Resource Centre DS0000032906.V284286.R01.S.doc Version 5.1 Page 18 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. 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 OP6 Good Practice Recommendations The deployment of staff, and specialist services from relevant professions including occupational and physiotherapists, should be kept under review and secured in sufficient numbers and with sufficient competence and skills, to meet the assessed needs of service users admitted for intermediate care / rehabilitation, day and night. Monument House Resource Centre DS0000032906.V284286.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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