CARE HOMES FOR OLDER PEOPLE
Morecambe Re-enabling Unit 29 Morecambe Road Morecambe Lancashire LA3 3AA Lead Inspector
Mrs Joy Howson-Booth Unannounced Inspection 13th October 2005 1.30 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 Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 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. Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Morecambe Re-enabling Unit Address 29 Morecambe Road Morecambe Lancashire LA3 3AA 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) 01772 825825 Calderdean Ltd Mrs Margaret Smith Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11) of places Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home shall at all times employ a suitably qualified and experienced manager who is registered with the National Care Standards Commission The home is registered to accommodate a maximum of 11 service users to include: Up to 11 service users in the category OP (older persons). Up to 2 service users in the category PD (physical disability) aged 45 years or over. 26th October 2004 Date of last inspection Brief Description of the Service: The purpose of Morecambe Re-Enabling Unit is to work with older people discharged from hospital and, with support, return to their own homes. A fulltime Manager and a team of staff manage the Unit. Ordinary living facilities are available within the Unit to enable residents to regain their daily living skills. To enable people to develop the skills and confidence to return home, the staff at the unit work alongside a variety of professionals, including occupational therapists, physiotherapists, rehabilitation social workers and health visitors. The re-enabling programme normally lasts for a period of one to six weeks but this can be extended to meet the residents’ needs, if required. The Unit is situated in a residential area of Morecambe and is close to the shops and amenities in Torrisholme. It is situated on the main bus route into Morecambe town centre. Residents are encouraged to maintain their links in the community by attending Day Centres and Over 60’s Clubs and recommence their hobbies and interests. Opportunities are provided for them to engage in social activities both insides and outside the Unit. Visitors are made welcome at anytime. Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which meant that the registered manager, the residents and staff did not know it would be taking place until the inspector arrived. The inspection was carried out over 3 hours and included talking with the registered manager, residents in the home at the time and a member of staff on duty. As well as this a range of care documents and staff files were examined. The home was toured and found to provide a clean, tidy and homely environment for the residents to use. Comment cards were sent to the home but none were received at the time of completion of this report. Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection?
Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 Page 7 The care planning system has been reviewed and revised to make it more user-friendly, with separate sections for individual areas of need. The assistant manager is undertaking the Registered Managers Award. 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. Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 Page 8 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 Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 Page 9 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 Residents are comprehensively assessed prior to admission, which means the staff are confident the prospective resident has the abilities to regain their independence and return to their own home. EVIDENCE: The files for two recently admitted residents were examined and found to contain the following - assessments from the social worker involved, hospital discharge information sheets, patient transfer forms from the hospital of discharge. In addition to this, as part of the Units assessment procedure, any prospective resident is personally visited by the manager of the Unit and their own assessment carried out. Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 Page 10 As outlined in the previous inspection report, Morecambe Re-Enabling Unit is a dedicated home with the ethos that people are supported to re-learn their skills and confidence to enable them to return home. The registered manager describes the service as being “dynamic” as all residents have their own individual presenting needs, wishes and circumstances from the point of referral. This diversification requires enthusiasm and skill on the part of both management and staff at the home. There is a range of equipment and facilities at the home, along with individual private space and communal areas, which the resident can access. Staff work alongside and under the guidance and instructions of a range of multi-disciplinary professionals (occupational therapists, speech therapist, dietician, G.P.’s, amongst others) to ensure that residents are appropriately supported and encouraged to regain their life skills. The registered manager ensures that staff receive the appropriate training from these professionals. The contracts for this service range from between 1 week to 6 weeks, although an extension can be agreed on a needs-led individual basis. Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 Page 11 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 and 10 The arrangements for residents to develop their personal care skills are excellent which means confidence is built up prior to returning home. The residents healthcare needs are well maintained which means residents go from strength to strength prior to returning home. Care is provided in a dignified and respectful way and the residents are very well cared for. EVIDENCE: Three case files were examined and found to be very well organised and providing a range of comprehensive information. The care files were divided into separate sections covering – discharge information, personal information, health and medical information, social skills, mobility and an additional section for any specialist health needs. There was evidence of weekly reviews where changes, improvements, etc., are noted.
Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 Page 12 There is evidence on these files of the involvement of other healthcare professionals, including GP, District Nurses, Physiotherapist and Occupational Therapist – all of whom provide specialist assessments, for example in mobility. A risk assessment is carried out at the point of admission and then as needed. The home provides care with a holistic approach, taking their lead from the clients wishes and hopes and is “needs-led”. The ethos of the home is that they never assume someone can’t do something but they work at the resident’s own pace. Re-Enabling residents to return to their own home often means the home has to recognise a range of issues that may mean the resident fails. This may mean organising some practical care before the re-enabling can begin, for example, the registered manager stated that it is difficult for a resident to do their mobility exercises if their feet are painful, so the home will make sure the resident sees a chiropodist as soon as possible. Once the resident feels confident to go to their own home, the staff at the unit provide additional support. Home visits are planned with the resident and their key worker and usually last for a couple of hours, then longer and then overnight. This will also involve a meal preparation by the resident. During this time, the staff involved work alongside the resident and other professionals to assess the situation and provide practical support, aids, etc., as identified. From discussions with one resident who is soon to return home it is clear how much this means to the resident in terms of reassurance, safety and support. Advice provided by the Pharmacist Inspector has been included in the home’s medication arrangements and, as most residents manage their own medication, generally involves a medical declaration being signed. Medications are checked out when a new resident arrives so that the registered manager is aware of any specific issues (side effects, contra-indications, etc). The registered manager confirmed the unit has a very good working relationship with the local pharmacist and is able to obtain advice over medication as needed. Given that all residents look after their own medication, staff are provided with in-house training in the safe handling of medications. 6 residents were spoken with and all were very positive about the care provided by the staff at the home. All confirmed their privacy and dignity is maintained at all times. Comments made by residents included “it’s like a 5 star hotel” and “the staff – they’re lovely”. Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 Page 13 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): No standards were assessed from this section EVIDENCE: Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 Page 14 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 The arrangements for dealing with complaints are good. Residents feel they can speak up and be listened to and their concerns addressed. EVIDENCE: Discussions with residents during this visit all confirmed that they had no complaints at all about the unit and all were aware of the complaints procedure and who to speak to if they were unhappy. In addition, residents were confident in the registered manager that any concerns would be addressed. The home has a written complaints procedure, which is included in the Resident Guide given to new residents prior to admission. No complaints have been received by the Commission for Social Care Inspection regarding this unit. The registered manager stated that there have no complaints been made about the home. Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 Page 15 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 and 26 The standard of the environment within this home is very good providing residents with an attractive and homely place to live. EVIDENCE: The location and layout of the home is suitable for its stated purpose. Residents spoken with were happy with their rooms. Residents felt the home was clean, tidy and providing a homely environment. There is an open plan to the communal areas which are decorated and furnished in a homely and pleasing fashion. Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 Page 16 All bedrooms are furnished to ensure the comfort of the residents with each bedroom providing the furniture required under this standard. All bedroom doors and bathroom doors are fitted with locks and a lockable facility is provided in each bedroom. The home and grounds continue to be maintained and in a good state of repair. There is a small courtyard in the centre of the building which is accessible to residents, and a parking area and small garden at the front of the home. During a tour of tour of the inside of the building it was noted that the home continues to be decorated to a good standard and furniture and furnishings met with the requirements of this standard. The registered manager was advised that the carpet in room 4 needs attention. The registered manager confirmed that she is aware that the shower room has an odour and is currently trying to locate the cause of this. The home does not have CCTV but there are security lights outside the home. Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 Page 17 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 The procedures for the recruitment of staff are robust and offer protection to the people living in the home. Staff are trained and competent to undertake the work they perform which means residents are enabled and supported appropriately to re-develop their independence. EVIDENCE: Staff files for two recently appointed members of staff were examined and found to contain all the required information. One file did not have a health declaration although the registered manager was aware of this as she wants the member of staff to complete and sign a new form that is being developed. Staff training files were seen and the registered manager confirmed that staff are undertaking National Vocational Qualification training at both Level II and Level III standards, with some staff just starting, some well on with the training and others having completed this training. The Assistant manager has almost completed the Registered Managers Award. In-house training is also offered from a range of external professionals and tends to depend on the specific needs of the residents accommodated. For example, one resident has had a hip replacement and the physiotherapist is to provide training in hip fractures and re-enabling.
Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 Page 18 Inductions are provided for new staff. Discussion with one member of staff confirmed the home’s recruitment procedure is thorough and also confirmed that induction training has been provided. Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 Page 19 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 36 The home is well managed and staff are appropriately supervised. Residents can be confident that their financial interests remain confidential and they can be provided with help on request. EVIDENCE: The registered manager has worked at the unit for a number of years and has been proactive in developing this service to the standard it has currently achieved. Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 Page 20 It has previously been established that the registered manager (Mrs Smith) has over 26 years experience in residential care of elderly people, and over 21 years in management of residential care homes. The registered manager has obtained the Registered Manager’s Award, is an Internal Quality Assurance Auditor for ISO and, in addition to being a D32/33 National Vocational Qualification Assessor, has achieved the Internal Assessor Course for NVQ training. The registered manager is aware of the conditions and diseases of old age and undertakes courses to update her training. A clear line of accountability is in place, and the home is seen in an open and transparent manner. The residents spoken with all confirmed they felt the home is very well managed and spoke highly of the registered managers support and management of the home. The registered manager confirmed that the home does not get involved in residents’ finances but will provide some assistance as identified from the multi-disciplinary meetings. There is a safe in the home which can be used for residents to deposit items or valuables. The home has a receipt book which is signed on deposit and also signed again by the resident when the item has been returned. The registered manager provides supervision for staff in the home and is aware this must take place 6 times a year. Records were seen and discussions with a member of staff on duty confirmed that supervision is carried out. Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 Page 21 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 4 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 17 X 18 X 3 X X X 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 3 X x Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 Page 22 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 OP29 Regulation 19(1)(b)(i ) Requirement A health declaration should be obtained for the new member of staff Timescale for action 01/11/05 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 Refer to Standard OP26 OP19 Good Practice Recommendations The odour in the shower room to be traced and eradicated The carpet in bedroom 4 should be repaired or replaced as it is beginning to fray and may pose a risk to residents Morecambe Re-enabling Unit DS0000059653.V258553.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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