CARE HOMES FOR OLDER PEOPLE
Normanton 168 Ellesmere Road Shrewsbury Shropshire SY1 2RJ Lead Inspector
Pat Scott Unannounced Inspection 7th June 2007 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 Normanton DS0000020715.V337710.R01.S.doc Version 5.2 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. Normanton DS0000020715.V337710.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Normanton Address 168 Ellesmere Road Shrewsbury Shropshire SY1 2RJ 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) 01743 271414 01743 271441 shedwards1@aol.com Mrs Mary Ursula Edwards Mr Kenneth Franklin Edwards Miss Samantha Edwards Care Home 29 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (2), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (8), Old age, not falling within any other category (19) Normanton DS0000020715.V337710.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home may accommodate a maximum of 29 service users. The home may accommodate 29 Elderly Persons, of whom up to 2 may be persons with a Mental Disorder, and 8 may be Elderly persons with a Mental Disorder. 8th August 2006 Date of last inspection Brief Description of the Service: Normanton is situated on the Ellesmere Road, approximately two miles from the centre of Shrewsbury and within easy access of all major services and amenities. The home is largely purpose built with the main living areas and majority of residents’ rooms being on the ground floor. It features 21 single rooms and 4 shared rooms, 22 of which have en suite facilities. Residents are able to enjoy attractive gardens to the front of the building with further lawns extending to the rear. Normanton is well equipped to provide for the frailest of residents supported by a good complement of appropriately trained staff providing consistency in a warm comfortable atmosphere. Normanton makes their services known to prospective service users in: The Statement of Purpose and Service Users Guide. The inspection report is available within the home. The care home rates are reviewed annually on 1st April each year and service users are notified one month in advance. The only additional charges to service users are for extra hairdressing, chiropody, newspapers, dentist and opticians. This is clearly laid out in the terms and conditions. Normanton DS0000020715.V337710.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider in the annual quality assurance assessment, staff records kept in the home, medication records, discussion with people who use the service, discussions with the staff team, discussion with the manager, tour of the premises, previous inspection reports, quality assurance processes, Fire Authority reports, Environmental Health Office reports, observation of care experienced by people using the service. What the service does well:
Significant time and effort is spent making admission to the home personal and well managed. Prospective residents and their families are treated as individuals and with dignity and respect for the life changing decisions they need to make. There is a high value on responding to individual needs for information, reassurance and support. Personal support is responsive to the varied and individual needs and preferences of the people who use services. The delivery of personal care is individual and is flexible, consistent and reliable. Staff respect privacy and dignity and are sensitive to changing needs. The service listens and responds to individuals’ choices and decisions about who delivers their personal care. People who use services are supported and helped to be independent and can take responsibility for their personal care needs. Staff listen to people who use services and take account of what is important to them. The ethos of the home is that it welcomes complaints and suggestions about the service, uses these positively and learns from them. Individuals and others associated with the home say that they are extremely satisfied with the service, feel safe and well supported. All Staff working at the service know the importance of taking the views of residents seriously, and of listening to and responding to raised issues. People who use services have confidence in the staff that care for them. The service ensures that all staff receive relevant training that is focussed on delivering improved outcomes for people using the service. The service puts a high level of importance on training and staff report that they are supported through training to meet the individual needs of people using the service. The manager is able to describe a clear vision of the home based on the service’s values and priorities. The manager communicates a clear sense of direction, is able to evidence a sound understanding and application of ‘best
Normanton DS0000020715.V337710.R01.S.doc Version 5.2 Page 6 practice’ operational systems, particularly in relation to continuous improvement, customer satisfaction, and quality assurance. Equality and diversity issues are given priority by the manager who is aware of the varying strands this involves. 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. The summary of this inspection report can be made available in other formats on request. Normanton DS0000020715.V337710.R01.S.doc Version 5.2 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 Normanton DS0000020715.V337710.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Key Standard 3 This judgement has been made using available evidence including a visit to this service. Written records for the admission of new people to the service demonstrate that the process is personalised and that consideration has been given to all aspects of care. EVIDENCE: The service maintains pre-admission and admission records. The records were seen of two new service users admitted. The assessments were personalised and addressed physical health, mental health, social care and spiritual needs of the individual. The manager keeps copies of the assessment summary and care plans of those carried out through care management arrangements. A service user spoken with stated that he had provided information about himself to the manager prior to coming to live at the home. Normanton DS0000020715.V337710.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Key Standards 7,8,9,10 This judgement has been made using available evidence including a visit to this service. Service users’ care needs and risk assessments are set out in their individual plans of care which ensures that all care needs have been addressed and will be fully met. The manager understands the need to comply with safe medication systems and staff practice ensures that the home’s procedures are complied with and that service users health matters are always safely addressed. The actions of staff and their approach to care ensures that service users are treated with respect and their right to privacy is upheld. EVIDENCE: Five care plans were examined. All had care plans derived from the initial assessments. Each plan had a recorded monthly evaluation of the elements of care. They provide detail in how care is to be delivered by staff. Assessments of care are reviewed on a six monthly basis.
Normanton DS0000020715.V337710.R01.S.doc Version 5.2 Page 10 Daily records monitor the progress of individuals but the service frequently uses statements such as ‘no problems’ which does not give a clear indication of how a person has spent their day. The plans demonstrate contact with healthcare professionals such as district nurse or GP. Service users spoken with stated that support is flexible as they spoke of the various bed/rising times which are accommodated and always delivered in a way that respects their privacy. One person awarded the staff ‘top marks’ for all they do. Other comments include ‘I feel able to call carers at any time’, ‘I am very satisfied with the service, it feels like my own home’. Service users all appeared well groomed with their hair, nails and clothes looking clean. No issues were identified in discussions regarding approach of staff or being assisted with intimate tasks. Two service users were being cared for in bed, by choice, and this was recorded within their plans. The service accepts responsibility for administering medication to service users via the monitored dosage system. The manager stated that none of the service users are self medicating at present. The service has suitable storage facilities but at present does not have storage for controlled drugs (CD) in the medication room. There are no service users with prescribed CDs at present being cared for in the home. The manager stated that she would provide correct facilities if the need arose. Written records for receipt and disposal are not maintained which the manager agreed to do. Normanton DS0000020715.V337710.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. Key Standards 12,13,14,15 This judgement has been made using available evidence including a visit to this service. Service users are provided with social activity and can keep in contact with family and friends. Social, cultural and recreational activities meet service user’s expectations through assessment, consultation and choice. Residents receive a healthy diet according to their assessed requirement and preference. EVIDENCE: The assessment process demonstrates that social/leisure pursuits are addressed prior to admission in a personalised way for the individual. Once living at the home, social activities are provided and the service shows that this is based on service user consultation through quarterly service user meetings regarding all aspects of living at Normanton. A service user pointed out the activities described on the board. Many photographs were on display of events. Newspapers, magazines and books were seen around the home with some people doing crosswords/quizzes or reading quietly. One service user goes work three mornings a week at a charity shop in town and is transported there by taxi. The hairdresser visits twice a week and staff help out if anyone needs their hair doing in between
Normanton DS0000020715.V337710.R01.S.doc Version 5.2 Page 12 these times. Service users stated that relatives and friends can visit at any time. A dedicated input of four afternoons per week is provided for activities by the co-ordinator. This provides for all tastes of leisure and hobbies in group or single formats. The co-ordinator reported she learns about new service users from feedback of the manager after the assessment process and tries to incorporate preferences into the programme. All service users spoken with said they liked the food and it is always nicely cooked. One service user has been living at Normanton for many years and helps out by taking sherry round to others on her trolley. She said she is very, very happy in the home and even when she goes out to visit people it’s ‘always nice to come back home’. The quality surveys conducted by the service in February 2007 showed 100 satisfaction with the activities. Normanton DS0000020715.V337710.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Key Standards 16,18 This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure which is accessible so that people who use the service have information of how to make complaints about the home. Training is provided so that service users are protected from abuse and have their legal rights protected. EVIDENCE: Service users spoken to say that they would go to the manager, owner or one of the staff if they had a problem. All expressed confidence that issues would be dealt with. Concerns spoken about by service users had been promptly dealt with and a satisfied outcome reached. These were mostly ‘minor’ comments and service users said they could put comments and/or suggestions in a box in the foyer. There is a high level of accessibility to the management at this home which ensures that concerns can be dealt with very quickly. Previous inspections have identified that staff receive full training on safeguarding adults. The manager reported she wishes to improve the training input by accessing certificated courses for all staff. Normanton DS0000020715.V337710.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. 19,26 This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home has improved, through service user choice, so that they live in a safer, better-maintained and comfortable environment, which encourages independence. EVIDENCE: The manager stated that the refurbishment improvement plan is to upgrade all the bedrooms, which has been mostly achieved, and then start on the main communal areas. All areas seen around the home are clean and rooms personalised and decorated according to the wishes of those service users occupying them. This has been welcomed by those living at the home and many favourable comments were made about the decoration. The choice and style of furnishings respects the diversity of service user groups regarding preference; for example not all elderly service users wanted ‘older style’ bedding and lampshades and wanted a fresh modern feel to their private space. The service has respected this viewpoint.
Normanton DS0000020715.V337710.R01.S.doc Version 5.2 Page 15 Handwash facilities are better with pump operated soap dispensers available where staff wash their hands. Call bell systems are working and are within reach of service users. A service user questionnaire stated that the laundry service is excellent. Normanton DS0000020715.V337710.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Key Standards 27,28,29 (not inspected as there have not been any new recruits), 30 (not inspected as no new inductions being conducted). This judgement has been made using available evidence including a visit to this service. Staff in the home are being trained and are in sufficient numbers to fill the aims of the home and meet the changing needs of service users. EVIDENCE: Staffing rotas are in place and a board displays the daily staffing compliment for the attention of anyone who wishes to view it. NVQ training is provided and the minimum ratio of 50 trained staff being at level 2 has been achieved. Other recent training provided includes; infection control and medication. The management and activity input is supernumerary to care staff numbers. Staff turnover in the home is low so that continuity of care is provided. The service users know the staff very well and observation showed that they provide a personal but professional service. Service users commented that staff are ‘very kind’, ‘excellent’ and ‘I have been to four other homes and this one is the best 10/10’.
Normanton DS0000020715.V337710.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. Key Standards 31,33,35,38 This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect and with effective quality assurance systems and audits in place, service users are assured that the overall conduct of the home is being well managed. EVIDENCE: The manager is highly competent to run the service and demonstrates a desire to continually improve the service to provide value for money. She is aware of the running costs of the home which herself and the owners have effectively used to provide better outcomes for service users, e.g. the injection of cash to fund the complete redecoration of the premises. The manager’s practice is very service user focussed and customer satisfaction is high on the agenda. This is
Normanton DS0000020715.V337710.R01.S.doc Version 5.2 Page 18 evidenced by the commitment to conducting service user surveys (last one February 2007), quarterly service user meetings that are minuted (last one May 2007) and including people who use day services in the consultation processes. People who use the service stated that they trust the staff and feel safe in the home. The manager demonstrated a commitment to the equality and diversity of service users by addressing needs arising out of age and mental health problems. Those service users who have a mental disorder are not segregated and care provision is inclusive of all living at the home. There is evidence of the review of policies and procedures in the home e.g. the manager has just reviewed the policy for visiting arrangements. Good record keeping systems are in place. All records seen are written in a way that shows the service listens to the people who use it. What people say is heard, acted upon and reviewed and elements of the annual quality self assessment were seen to be in place. E.g. trolley shop, particular activities, reviewed policies and staff training. Normanton DS0000020715.V337710.R01.S.doc Version 5.2 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 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 N/A 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 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 3 Normanton DS0000020715.V337710.R01.S.doc Version 5.2 Page 20 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 2 3 Refer to Standard OP7 OP9 OP9 Good Practice Recommendations The term ‘no problems’ should be avoided when recording the daily progress in the care plans. The storage of medication could be improved by having a CD box in place in case a service users medication is changed. The manager should record the receipt and disposal of all medication. Normanton DS0000020715.V337710.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate Shrewsbury SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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