CARE HOMES FOR OLDER PEOPLE
Neilston 47 Woodway Road Teignmouth Devon TQ14 8QB Lead Inspector
Mark Sharman Unannounced Inspection 20th June 2006 09:30 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 Neilston DS0000003759.V289802.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. Neilston DS0000003759.V289802.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Neilston Address 47 Woodway Road Teignmouth Devon TQ14 8QB 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) 01626 774221 01626 879395 joy@neilston.info Mr John Bryant Wescott Mrs Joy Wescott Care Home 22 Category(ies) of Dementia (22), Old age, not falling within any registration, with number other category (22) of places Neilston DS0000003759.V289802.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: None. Date of last inspection 17/01/06 Brief Description of the Service: Neilston is registered to provide accommodation and care for a maximum of twenty-two people who are elderly and who may also have dementia. The home is situated on a hill in a quiet residential area of Teignmouth, and is approximately one mile from the town centre. It is a detached house with a substantial garden, and there is ample car parking on the road outside. All but two of the bedrooms are registered as single rooms and all of them have ensuite toilet/washbasin facilities. There is a large lounge and a large dining room with an adjoining conservatory, used as a second lounge area. There is a stair lift to the first floor. The registered providers (owners) are Mr John Wescott and Mrs Joy Wescott who live on the premises. Mrs Wescott manages the home on a day-to-day basis while her husband takes responsibility for the upkeep of the house and garden. The care staff and Mrs Wescott do most of the cleaning and prepare meals, since domestic staff are not specifically employed. There is one member of staff awake at night to provide care from 8pm to 8am, although the owners and some care staff who live on the premises are available on call at night. Neilston DS0000003759.V289802.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection during which the home was visited over two consecutive days. Before the inspection visit a variety of information about the home was received. This included a pre-inspection questionnaire completed by the owner/manager (Mrs Wescott), four survey forms from residents, eight forms from relatives and eight forms from care workers at the home. A sample of the home’s care records was examined. Time was spent with Mrs Wescott and several of the residents and staff were consulted, plus one visiting relative. A tour of the premises was made, including the communal areas and all of the residents’ bedrooms. What the service does well: What has improved since the last inspection?
Neilston DS0000003759.V289802.R01.S.doc Version 5.1 Page 6 Specialist training has been ongoing for Mrs Wescott and the staff on the provision of person centred care for people with dementia. Other training relevant to the care of this client group has also continued in recent months. Mrs Wescott reported that three new carers have been recruited since the last inspection. Although some care staff hours have also been lost there has been a slight overall increase in the available hours. A complaints book has now been started to record complaints made to the home, as required at the last inspection. If this is looked at periodically it should help to identify any possible pattern of complaints over time. What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
Neilston DS0000003759.V289802.R01.S.doc Version 5.1 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Neilston DS0000003759.V289802.R01.S.doc Version 5.1 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 Neilston DS0000003759.V289802.R01.S.doc Version 5.1 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): 1, 3 and 6. (Standard 6 is inapplicable). Quality in this outcome area is adequate. Satisfactory information about the home and its facilities and services is available for prospective service users. Professional external assessments are carried out on new service users, although the home’s own assessments are sketchy. EVIDENCE: The home’s Statement of Purpose and Service User’s Guide include all of the information required and recommended in the Care Home Regulations and National Minimum Standards, and provide information for current and prospective service users and their representatives about how the service should be provided. Four of the residents’ individual files were examined, and all of these contained an assessment form completed by the local authority care manager involved. Mrs Wescott uses a commercial assessment form to record her own assessment of the person’s needs and this has now been supplemented with another form. However these are largely “tick box” forms which were not fully completed in each case, and in three of the files there was no information about the person’s social history, interests and background. This type of
Neilston DS0000003759.V289802.R01.S.doc Version 5.1 Page 10 information is especially important to enable appropriate social care to be provided to confused people (and most of the residents accommodated at Neilston are significantly confused). Neilston DS0000003759.V289802.R01.S.doc Version 5.1 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): Quality in this outcome area is generally poor. The residents’ individual care plans do not set out in detail how their health, personal and social care needs are to be met. The residents’ health care needs are being adequately met, although there were some shortfalls in the home’s medication practice. EVIDENCE: Four of the residents’ individual files were examined. Each of these contained a commercially produced assessment/care plan, but the care plans were brief and all contained only general instructions to staff such as “needs prompting” and “needs stimulation”. Thus all four care plans looked very similar to each other which suggested that the care provided was not individual, personcentred care. There was no indication of actions to be taken to try to ensure that social care needs are met. There was little evidence of a risk assessment having been done (just an indicated level of risk) in three of the files, so that staff were not informed of particular situations in which a resident might be at risk. The care plans had not been signed by the resident (probably not appropriate) or a representative, so there was no evidence of a relative’s involvement in the care planning process. The standard of physical care is satisfactory, and indeed the residents looked well presented and their clothing was well laundered. Mrs Wescott is a qualified
Neilston DS0000003759.V289802.R01.S.doc Version 5.1 Page 12 nurse (trained in the Philippines) and is able to identify when the residents need professional health care support. Recent daily records inspected showed that four residents had received twice weekly visits from a district nurse in the last couple of weeks and there had been two general practitioner visits in that time. The home has quite regular contact with a community psychiatric nurse from the specialist mental health team. Residents’ medication was stored in a locked cupboard, but this is not of a type suitable for controlled drugs (which require more secure storage). The medication administration recording sheets were examined for the day of the inspection. These had been correctly signed by the staff except in one case which was pointed out to Mrs Wescott. It is important that these sheets are signed only at the time when the medication is given to the residents. The home has a brief policy in respect of death and dying, but recently a district nurse and a health care assistant complained about the insensitive attitude shown by Mrs Wescott towards the daughter of a very recently deceased resident. It is recommended that the home’s policy should be amplified in line with the Standard. Neilston DS0000003759.V289802.R01.S.doc Version 5.1 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): 12, 13, 14 and 15. Quality in this outcome area is adequate. The more capable residents are able to make choices with regard to some of their daily routines, and most residents have contact with their relatives/friends. Some activities are offered but this is limited and should be expanded. The catering arrangements are satisfactory. EVIDENCE: One of the regular day carers said that she always runs an activity session in the afternoon, which was confirmed by residents spoken with. This can be exercises, bingo, games, crafts, a quiz or a sing-along. Additionally staff and residents said that professional musical entertainers visit monthly. There is a pleasant garden, and the daily records showed that some residents are taken out for a walk with staff. Mrs Wescott said that she sometimes takes three of the residents out for a drive. The staff observed were kind and caring to the residents, but they are expected to do cleaning and catering tasks in addition to their caring role and they have little time to spend talking to individual residents. The residents’ files which were inspected showed that insufficient information is obtained about their personal backgrounds and their individual interests, preferences and capabilities. It is thus difficult for the staff to provide person centred care. Some of the residents said that they regularly have relatives or friends visiting them at the home, and this was confirmed by inspection of the visitors book
Neilston DS0000003759.V289802.R01.S.doc Version 5.1 Page 14 and the day book (maintained by the staff). One visiting relative was spoken with, who said that so far he was pleased with the service provided to his mother. Mrs Wescott and the care staff prepare the residents’ meals. All (except one) of the residents spoken with said the food provided is good, and the residents’ survey forms received also confirmed this view. The lunches served during the inspection looked appetising. Neilston DS0000003759.V289802.R01.S.doc Version 5.1 Page 15 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 and 18. Quality in this outcome area is adequate. Residents should be protected from abuse if the home’s policies are followed. Not all of the residents seemed confident that a complaint would be taken seriously and acted upon. EVIDENCE: The home’s complaints procedure is included in the Statement of Purpose and the Service Users’ Guide, and a copy was displayed in the home. The complaints book contained a recent entry. One complaint has been received by the Commission for Social Care Inspection since the last inspection, which was substantiated. An allegation was also received about the treatment of a resident by Mr Wescott, which was investigated by the Commission for Social Care Inspection (no further action was taken). The home has an abuse policy (Protection of Vulnerable Adults) and a copy of local adult protection procedures. Several staff received vulnerable adult training recently. The care staff survey forms received indicated that they are aware of adult protection procedures. Neilston DS0000003759.V289802.R01.S.doc Version 5.1 Page 16 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, 20, 22, 24 and 26. Quality in this outcome area is generally good. The house and gardens looked reasonably well maintained, the home is comfortable and was found to be clean. A portable hoist is needed in the interests of the health and safety of both staff and residents. EVIDENCE: All parts of the home were seen and were clean and tidy, including bathrooms and WCs. There was an odour in two of the bedrooms which was pointed out to Mrs Wescott. All bedrooms are used as single rooms and all have en suite facilities. The communal rooms are comfortable and pleasant, and there were flowers on the dining tables. The laundry (in the basement) is reasonably well equipped. The garden is accessible and looked attractive, although rather spoiled by stacks of old timber, building materials and two small boat hulls. There were also two disused vehicles parked at the front which detract from the appearance of the home. A qualified occupational therapist carried out an inspection of the premises in January 2005 with regard to disability equipment and adaptations, and the
Neilston DS0000003759.V289802.R01.S.doc Version 5.1 Page 17 report was generally favourable. However a portable hoist for use with residents with reduced mobility has not yet been obtained, as required following the last inspection by the Commission for Social Care Inspection. From discussion with the staff it was evident that this is a necessary piece of equipment. Neilston DS0000003759.V289802.R01.S.doc Version 5.1 Page 18 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. Quality in this outcome area is generally poor, although there is a stable group of good carers. There are not enough care staff hours to fully meet the needs of the residents, and the recruitment practices are not sufficiently robust to ensure that only suitable staff will be employed. The staff have received appropriate training in the last year or so. EVIDENCE: Although overall the staff hours available have been increased in recent months, it was evident during the inspection that the staff have little time to spend with the residents other than when helping them with personal care. No domestic staff are employed, and so the staff have to carry out cleaning and catering duties in addition to their caring role. It was apparent from talking to them that they are not able to spend much time in conversation with residents. Most of the residents of Neilston are confused and unable to initiate activities for themselves, and so are particularly reliant on the staff for stimulation and occupation. Those residents who were able to express a view all said that the staff are kind and helpful. Indeed the staff were seen to be helpful and patient with the residents throughout the inspection, although they were busy with domestic tasks for much of the time. Four of the carers’ files were examined and the recruitment practice described in the Standard is not being followed consistently. Criminal Records Bureau disclosures are not being applied for in a timely way, and one carer was
Neilston DS0000003759.V289802.R01.S.doc Version 5.1 Page 19 employed in spite of the previous employer (care home) refusing to give a reference. An inspection of staff records showed that the staff have had recent training in health and safety related topics, including food hygiene, fire safety, medication, manual handling, and dementia care. Three of the foreign nationals are qualified nurses (trained in the Philippines), one carer has an NVQ in Care at Level 2 and two have NVQ at Level 3 (these certificates were seen). Another carer is currently working towards NVQ at Level 2. Thus the 50 NVQ target is currently met. Neilston DS0000003759.V289802.R01.S.doc Version 5.1 Page 20 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, 33, 35, 36 and 38. Quality in this outcome area is adequate. The manager is qualified and well experienced, but a more systematic approach is needed in respect of quality monitoring in order to measure success in meeting the aims of the home. EVIDENCE: Mr and Mrs Wescott have now run the home for about eighteen years. Mrs Wescott is a nurse who was trained and qualified in the Philippines and she takes responsibility for the day-to-day running of the home. She has the Registered Managers Award (NVQ Level 4), is a qualified NVQ assessor (D32/33) and has undertaken periodic training to update her skills and knowledge. Quality assurance is carried out largely in an informal way, although some visitor questionnaires have been gathered recently (some were seen). Mrs Wescott lives on the premises and sees all the residents and staff frequently, including the night carers. Most of the carers’ survey forms
Neilston DS0000003759.V289802.R01.S.doc Version 5.1 Page 21 indicated that the staff receive supervision from Mrs Wescott, but this has not been recorded in recent months. With regard to residents’ personal money Mrs Wescott said that she looks after the personal allowances on behalf of just two residents. These financial records were available and were satisfactory and included receipts for money spent on behalf of the residents. Health and safety issues are in general managed satisfactorily. Mrs Wescott said that all radiators are guarded, windows are restricted and the hot water supply to baths is regulated. Some of the radiators and windows were checked. However the home needs a portable hoist to ensure that the staff and residents are not put at risk when residents with very limited mobility are being moved. Neilston DS0000003759.V289802.R01.S.doc Version 5.1 Page 22 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 3 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 3 x 2 x 3 x 3 STAFFING Standard No Score 27 1 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 2 x 2 Neilston DS0000003759.V289802.R01.S.doc Version 5.1 Page 23 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 OP3 Regulation 14 Requirement The home’s own assessment of needs in respect of a new resident must include more information about the person’s social interests, hobbies, religious and cultural needs. The residents’ care plans must set out in detail the actions that need to be taken by the staff to meet the residents’ individual health, personal and social care needs. The care plans must include a risk assessment with written guidance for the staff on how to reduce any risks identified. Timescale for action 31/07/06 2 OP7 15 31/08/06 3 OP9 13 4 OP9 13 5
Neilston OP12 16 Any controlled drugs 30/07/06 administered by staff must be stored in a metal cupboard which complies with the Misuse of Drugs (Safe Custody) Regulations 1973. 20/06/06 The medication administration recording sheet for each resident must be signed by the staff only at the time when the medication is given to the resident. More activities and opportunities 31/08/06
DS0000003759.V289802.R01.S.doc Version 5.1 Page 24 6 OP22 13 7 OP27 18 8 OP29 19 9 OP37 37 for stimulation must be available for residents which suit their interests and preferences. The registered providers must ensure that the staff and residents are not placed at risk by ensuring that suitable equipment and training is provided where a risk has been identified. This refers specifically to unsafe lifting practice and the failure of the registered providers to provide a suitable hoist. (Previous requirement of 17/01/06 not met). Care staffing levels must be based on the assessed needs of the residents and must be sufficient to meet their health, personal and social care needs. A Criminal Records Bureau disclosure must be obtained for all new staff as soon as possible, including staff who are foreign nationals. (Previous requirement of 18/01/06 not met). The registered providers must give notice to the Commission for Social Care Inspection without delay of any incident specified by Regulation 37. 31/08/06 31/08/06 20/06/06 20/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1
Neilston Refer to Standard OP11 Good Practice Recommendations The home’s policy on dealing with death and dying should
DS0000003759.V289802.R01.S.doc Version 5.1 Page 25 2 3 OP33 OP36 be amplified in line with Standard 11. A systematic quality assurance/quality monitoring system should be introduced to enable the service providers to evaluate and develop the service. All care staff should receive formal supervision at least six times a year. Neilston DS0000003759.V289802.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© 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 Neilston DS0000003759.V289802.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
