CARE HOMES FOR OLDER PEOPLE
Newhaven 5 Sunningdale Road Wallasey Wirral CH45 0LU Lead Inspector
Inger Moynihan Unannounced 22 August, 2005 9:30 am 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 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. Newhaven F52 F02 S18915 Newhaven V244896 220805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Newhaven Address 5 Sunningdale Road Wallasey Wirral CH45 0LU 0151 639 6420 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Danny So Mr Danny So (CRH) Care Home 16 Category(ies) of LD(E) Learning Disability - 16 registration, with number of places Newhaven F52 F02 S18915 Newhaven V244896 220805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Only five adults with a learning disability and eleven elderly people with a learning disability may be accommodated within the maximum number of sixteen. One named adult with a learning disability under the age of 65 years (six weeks respite care) within the maximum number of sixteen. Date of last inspection 9 February 2005 Brief Description of the Service: Newhaven is registered to provide care for 16 elderly people with a learning disability. The house consists of two adjacent semi-detached houses in a quiet residential area of New Brighton, close to shops, a bus route, other community facilities and the seafront. Accommodation is provided in six single and five shared rooms. Six bedrooms have en suite facilities. There is a large lounge/dining room, which overlooks the road to the front and a small lounge to the side of the main living area. The home has a large garden at the rear, which has fixed garden furniture and is reached via a patio door. Newhaven F52 F02 S18915 Newhaven V244896 220805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 4 hours and was the statutory announced inspection for 2005/2006. A tour of the premises took place and staff and service users records were inspected. Three staff and two service users were spoken to during this inspection. Observations were also made on the service user group. What the service does well:
A comprehensive assessment of service users care needs has been completed to ensure staff can provide the appropriate package of care to each of the service users. A range of social activities are offered to service users to ensure an interesting and stimulating environment is provided. Varied and balanced meals are provided to ensure service users health and interest. The home has a comprehensive complaints procedure to ensure service users, carers and stakeholders views are listened to and acted upon. Systems are in place to ensure service users are safeguarded from abuse and harm and staff have completed appropriate training in this aspect of care. Staff are provided with appropriate training to ensure they are suitably qualified to care for the service users and to ensure they are up to date with current good practice. A member of staff commented that the senior staff were always available for support and advice when necessary. The health, safety and welfare of the service users is promoted throughout the home. One of the service users spoken to during inspection praised the staff for their kind and caring manner. She stated she enjoyed the meals and confirmed the routines within the home are flexible. Newhaven F52 F02 S18915 Newhaven V244896 220805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better:
Some of the requirements from the last inspection remain outstanding. There is no clear and consistent care planning system in place to adequately provide staff with the information they need to satisfactory meet service users needs. Service users physical and mental health is maintained through regular contact with healthcare professionals, however it was not possible to establish the accuracy of this information as the care plans were not in place. Improvements need to be made to the medication administration procedures to ensure staff are provided with guidance on when medication should be administered on the basis of as and when required. The standard of the decor is mixed with some parts of the home being maintained to a good standard and other parts being in need of attention. The home does not therefore, present as a homely and comfortable environment throughout. There is a shortfall in the domestic staffing levels which the registered person is required to address as this situation may result in care staff being taken away from their duties to carry out domestic tasks. There is some inconsistency in the management of the home as it was reported that the deputy manager is in day to day control of the home rather than the registered manager. This issue was discussed with the registered manager who agreed to ensure he fulfilled his responsibilities or propose
Newhaven F52 F02 S18915 Newhaven V244896 220805 Stage 4.doc Version 1.40 Page 7 another member of staff for this position. The systems in place for the administration of service users finances are poor which prevented the records from being audited effectively. 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. Newhaven F52 F02 S18915 Newhaven V244896 220805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Newhaven F52 F02 S18915 Newhaven V244896 220805 Stage 4.doc Version 1.40 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 standard(s) 3 A comprehensive assessment of service users care needs has been completed which ensures staff can provide the appropriate package of care to each of the service users. EVIDENCE: Documentation examined indicated that a comprehensive assessment of service users care needs has been carried out to ensure the staff at the home are able to support the service users in accordance with their particular needs. All of this documentation was well organised although the registered manager must identify the level of risk identified following completion of any risk assessment. All of this information has been discussed with the staff team. During discussion a member of staff stated she had never seen any of the risk assessments completed in relation to service users care needs. It is vitally important that all staff are aware of the potential risks service users are exposed to on a day-to-day basis, as not having this information could leave both staff and service user vulnerable to the risk of harm. Newhaven F52 F02 S18915 Newhaven V244896 220805 Stage 4.doc Version 1.40 Page 10 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 standard(s) 7, 8 and 9 There is no clear and consistent care planning system in place to adequately provide staff with the information they need to satisfactory meet service users needs. Service users physical and mental health is maintained through regular contact with healthcare professionals, however it was not possible to establish the accuracy of this information as an up-to-date care plan is not in place. Thorough medication administration procedures are in place which ensures service users good health and safety, however not all of the necessary guidance was in place. EVIDENCE: Detailed care plans had yet to be compiled from the information gathered during the assessment process. And the existing care plans had actually been removed in order for new, more detailed care plans to be put in place. To ensure service users care needs are being met, the registered person is required to ensure a documented plan of care is always in place. Without this, important aspects of service users care needs may be missed and both staff and service users may be left vulnerable to the risk of harm. Service users healthcare needs are met through the support of the care staff at the home and regular contact with a variety of healthcare professionals. However it was not entirely possible to establish whether the information
Newhaven F52 F02 S18915 Newhaven V244896 220805 Stage 4.doc Version 1.40 Page 11 documented accurately reflected service users healthcare needs as the care plans had been removed. A record of service users daily welfare is maintained although the registered person is required to ensure staff sign and date all records. This will ensure staff and other healthcare providers are clear on what is the most current information. Thorough systems are in place for the administration of medication which ensures service users medical needs are met. However, in one instance no guidance had been compiled on the circumstances under which medication should be given on the basis of as and when required. To ensure service users medication is given appropriately, the registered person is required to ensure guidance is documented and discussed with staff around when medication administered under these circumstances should be given. Newhaven F52 F02 S18915 Newhaven V244896 220805 Stage 4.doc Version 1.40 Page 12 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 standard(s) 12 and 15 A range of social activities are offered to service users to ensure an interesting and stimulating environment is provided. Varied and balanced meals are provided to ensure service users health and interest. EVIDENCE: Service users social care needs are assessed and work is being undertaken to develop this side of the service. A range of board games etc., have been purchased for the home and some service users are involved in local day care facilities. The home has a mini bus which enables service users to become more involved in the local community. The activities are provided on an individual or group basis. To ensure service users interest and good health, a more varied diet is now in place and special diets are catered for upon request. One of the service users spoken to during inspection praised the staff for their kind and caring manner. She stated she enjoyed the meals and confirmed The routines within the home are flexible. Newhaven F52 F02 S18915 Newhaven V244896 220805 Stage 4.doc Version 1.40 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The home has a comprehensive complaints procedure to ensure service users, carers and stakeholders views are listened to and acted upon. Systems are in place to ensure service users are safeguarded from abuse and harm and staff are suitably qualified to promote this aspect of care. EVIDENCE: The home has produced a complaints procedure which includes the name and contact details of the CSCI. The CSCI has not received any complaints about the service within the last 6 months and no complaints have been received by the registered provider. A copy of the Wirral adult protection procedure and supporting documentation is in place. Staff spoken to were aware of the action they should take in the event of them suspecting or knowing an incident of abuse had taken place. The senior member of staff conducting the inspection reported that all staff have now completed training on the protection of vulnerable adults from abuse which ensures service users safety and welfare. However, one member of staff stated she had not completed this training. To ensure service users protection, the registered person is required to ensure all staff are provided the training around the protection of vulnerable adults from abuse. Newhaven F52 F02 S18915 Newhaven V244896 220805 Stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The standard of the decor is mixed with some parts of the home being maintained to a good standard and other parts being in need of attention. The home does not therefore, present as a homely and comfortable environment throughout. The home is clean and tidy throughout. EVIDENCE: The standard of the decoration throughout the home is mixed with some areas being decorated in a way that provides a homely environment and other parts, primarily the bedrooms, en suites and bathrooms being in need of attention. the following issues were raised in relation to the standard of the facilities: • • • • • • • Lino was fitted in one of the bedrooms where it was no longer required. water pipes needed boxing in no light shade was fitted in the first-floor toilet and bathroom the light bulb in one of the en suites was broken no light bulb was fitted in one en suite grouting had become blackened there was a strong smell of urine in one of the bedrooms
F52 F02 S18915 Newhaven V244896 220805 Stage 4.doc Version 1.40 Page 15 Newhaven • • • • one of the commodes was extremely rusty and needed to be disposed of (this was replaced during the inspection ) no dividers were supplied in one of the double bedrooms where service users needed to use a commode no toilet roll holder or towel was provided in the ground floor toilets metal framed beds that were very institutional in appearance were being used. For service users comfort and welfare the registered person is required to address the issues raised. Equipment held at the home is serviced regularly. In addition to the service agreements, the registered person is required to carry out more frequent inhouse checks to ensure all of this equipment is in good working order each day. The registered person is also advised to keep up-to-date with all information issued on the Medical Devices Agency Website. In light of the fact that the service users living at Newhaven are elderly and may experience poor eyesight, the registered person must ensure good light levels are provided throughout the home at all times. Not having this in place could leave service users vulnerable to the risk of an accident. The standard of hygiene throughout the home is good. The staff spoken to during inspection confirmed they had sufficient equipment and cleaning materials to carry out their work. The current laundry facilities are adequate and systems are in place to prevent the spread of infection. Newhaven F52 F02 S18915 Newhaven V244896 220805 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Staff numbers and skill mix of staff meet the service users assessed needs; although there is a shortfall in the domestic staffing levels. Staff are provided with appropriate training to ensure they are suitably qualified to care for the service users and to ensure they are up to date with current good practice. EVIDENCE: The staff rota indicated the care staff were evenly deployed across the week and that the required staffing levels as agreed by the registering authority are provided. The senior member of staff stated the required domestic staffing levels are not met and the registered provider is required to address this issue to ensure the care staff are not taken from the work for this purpose. Staff are provided with a range of appropriate training to ensure the care provided is in line with service users care needs. Arrangements have also been made for staff to complete training in specific care issues later in the year. No new staff have been employed in the home since the last inspection. This is a positive aspect of the home as this provides consistency in the care given to service users and enables positive working relationships to develop. Newhaven F52 F02 S18915 Newhaven V244896 220805 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 35 and 38 There is some inconsistency in the management of the home as it was reported that the deputy manager is in day to day control of the home rather than the registered manager. The systems in place for the administration of service users finances are poor which prevented the records from being audited promptly. The health, safety and welfare of the service users was promoted throughout the home. Newhaven F52 F02 S18915 Newhaven V244896 220805 Stage 4.doc Version 1.40 Page 18 EVIDENCE: It was confirmed that the deputy manager has day to day control of the management of the home rather than the registered manager. This issue was discussed in some detail with the registered manager and it was agreed that he would resume day to day management of the home and would make a decision as to whether or not he wished to propose the deputy manager for registration. A member of staff commented that the senior staff were always available for support and advice when necessary. The systems in place for the administration of service users finances held insufficient detail which meant an audit of these records could not be made. This issue was discussed with the registered provider/manager during which time advice and guidance was given on to how to improve these systems. This issue however will be followed up after the inspection. Examination of documentation and discussion with staff confirmed that service users safety and safe working practices were promoted within the home and staff were provided with appropriate training for this purpose. Regular fire safety checks and checks on all equipment and water temperatures are carried out. For the further promotion of issues relating to service users health and safety, the registered person is advised to keep up-to-date with the information issued on the Health and Safety Website. Newhaven F52 F02 S18915 Newhaven V244896 220805 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 1 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x x x 1 x x 3 Newhaven F52 F02 S18915 Newhaven V244896 220805 Stage 4.doc Version 1.40 Page 20 Yes Are there any outstanding requirements from the last inspection? 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 19 Regulation 23 Requirement The registered person is required to ensure a detailed care plan is in place for each of the service users. The registered preson is required to ensure staff are provided with guidance on when to administer medication on the basis of as and when required. The registered person is required to replace the metal framed beds with something more domestic in character. The registered person is required to provide carpet in the bedrooms where lino is currently fitted. The registered person is required to ensure the water pipes that have become blackened are made good. The registered person is required to ensure a light shade is fitted in the first-floor toilet and bathroom. The registered person is required to ensure a light bulb is fitted to all light sockets. The registered person is required to make good the grouting that has become blackened in the
F52 F02 S18915 Newhaven V244896 220805 Stage 4.doc Timescale for action 22/9/05 2. 9 17 1/10/05 3. 19 23 1/12/05 4. 19 23 1/11/05 5. 19 23 1/11/05 6. 19 23 1/11/05 7. 8. 19 19 23 23 1/11/05 1/11/05 Newhaven Version 1.40 Page 21 bathrooms. 9. 10. 11. 12. 19 19 19 19 23 23 23 23 The registered person is required to address the smell of urine in one of the bedrooms. The registered person is required to ensure all commodes are in a good state of repair. The registered person is required to ensure dividers are provided in double bedrooms. The registered provider is required to ensure all bathrooms are provided with toilet roll holders and towels. The registered person is required to ensure the minimum domestic staffing hours are provided at all times. The registered person is required to ensure more detailed records are kept of service users finances in order that they can be audited effectively. The registered person is required to ensure the level of risk is identified in all risk assessments completed. The registered person is required to ensure all staff are provided with training on the protection of vulnerable adults from abuse. The registered person is required to ensure regular checks are carried out on all equipment used the home. A record of these checks must also be kept. The registered person is required to ensure all staff are up-to-date on the risks assessments that have been completed for each of the service users. 1/11/05 1/11/05 1/11/05 1/11/05 13. 18 27 1/11/05 14. 17 35 1/11/05 15. 14 14 1/11/05 16. 18 18 1/11/05 17. 19 23 1/11/05 18. 3 14 1/11/05 Newhaven F52 F02 S18915 Newhaven V244896 220805 Stage 4.doc Version 1.40 Page 22 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 38 Good Practice Recommendations It is recommended that for service users safety and welfare, the registered person should keep up-to-date with the information provided on the Medical Devices Agency Website and the Health and Safety Executive Website. Newhaven F52 F02 S18915 Newhaven V244896 220805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 3rd Floor, Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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