CARE HOMES FOR OLDER PEOPLE
Northernhay Townstal Pathfields Dartmouth Devon TQ6 9HL Lead Inspector
Megan Walker Unannounced Inspection 21st March 2006 11:30 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 Northernhay DS0000003761.V287214.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. Northernhay DS0000003761.V287214.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Northernhay Address Townstal Pathfields Dartmouth Devon TQ6 9HL 01803 833964 01803 835186 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) Mrs Jane Susan Garland Mrs Jane Susan Garland Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Northernhay DS0000003761.V287214.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 1st June 2005 Brief Description of the Service: Northernhay is a converted and extended house, set in a quiet residential area above the town of Dartmouth. The home is able to provide accommodation for up to eighteen older people over three floors. The first floor is accessed via a passenger lift and the lower ground floor by a stair lift. On the ground floor is a lounge, a separate sun lounge and a dining room. The home has bathing aids; mobile hoists, and thirteen of the sixteen single bedrooms are en-suite, as is the one double. There are a further four WCs. There is an assisted bathroom on each floor. The homes kitchen is in the process of being upgraded, which will almost double its size. The home has attractive gardens front and back. The home is registered to provide care for up to eighteen people who require 24hr care for reasons of old age. The home does not provide intermediate care and it is not registered to provide nursing care. Northernhay DS0000003761.V287214.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 on Tuesday 21st March between 11h30 and 15h00. Mrs Jane Garland, Registered Provider and Manager, and Mrs Kim Paddon, Senior Supervisor, were present for the inspection and assisted in providing information as required. They also provided a tour of the premises during the inspection. Other members of staff were on duty during the inspection and were introduced to the inspector. At the time of this inspection there were only seven residents living at Northernhay of which five offered an opinion about the lifestyle and living at the home. During the inspection a relative visited the home and offered views about the care provided by the home to his relative, as did a local GP who spoke about the overall care provided by Northernhay to all its residents. At the time of this inspection the home had two cats living there, both had been pets of previous residents (now deceased). Observation during this inspection showed the cats were clearly loved and appreciated by the residents. What the service does well:
Mrs Garland and her staff provide a high standard of care and respect to each of their residents. They take time to get to know every resident, their likes, dislikes and personal preferences. Mrs Garland has very high standards and expectations of any staff in her employ. Any issues are dealt with immediately to prevent anything growing out of proportion and context, and all staff are informally supervised on a daily basis. One notable observation during the inspection was that all staff, including Mrs Garland, not only knocked on residents’ bedroom doors before entering, they always knocked on doors leading into communal areas too. Staff attitude is very much that Northernhay is the residents’ home and that they, the staff, should be courteous and treat it as such. The Registered Provider and staff are commended for this. The atmosphere in the home encourages residents to feel at home and to enjoy an easygoing lifestyle with very few restrictions other than those designed to protect residents and ensure their safety. The home provides a comfortable, homely environment. Residents can bring in their own personal belongings if they so wish, and each bedroom is arranged to suit individual choice and preference. Northernhay DS0000003761.V287214.R01.S.doc Version 5.1 Page 6 Everyone spoken to praised the service offered by Mrs Garland and her staff at Northernhay. Two of the residents commented that if they had realised that living in a care home was “like this”, they would have moved in much sooner. Visitors spoke very highly of the care given to each resident and also the welcome extended to visitors. Dartmouth is a small community with only one medical practice and a local “cottage” hospital. This enables the home to have good medical support and also allows residents who move from their homes in Dartmouth into Northernhay, to stay with the same GP. Because of the level of medical support residents are able to remain at the home when they are unwell even when they are dying, if this is their choice, and be cared for by the staff with support from the district nurses and GPs. Most of the current residents have lived at Northernhay for a number of years and Mrs Garland strives to offer them a “home for life”. Most referrals to the home are word of mouth, again due the size of the town and local community, and the reputation of the home in this area. 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. Northernhay DS0000003761.V287214.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Northernhay DS0000003761.V287214.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were inspected at the previous inspection EVIDENCE: Northernhay DS0000003761.V287214.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11 Residents can feel assured that all measures to meet their last wishes are met, and that their death will be dealt with sensitively and respectfully by all staff. EVIDENCE: At the time of this inspection staff were involved with funeral preparations for two residents whom had died within the previous two weeks. They were observed as dealing with this subject sensitively, and assisted grieving relatives with any matters as they arose. It was also apparent that staff themselves were in a period of mourning for the deceased residents, both of who had lived at the home for a number of years. Nonetheless they continued to maintain a professional manner towards their daily work, and in the ongoing care of the current residents. Mrs. Garland confirmed that each resident is asked about their wishes for when they are dying, and after death. This is recorded on the individual’s care plan. Both Mrs Garland and Mrs Paddon stated that the home is fortunate in having very good medical support from the local GP practice and the local hospital
Northernhay DS0000003761.V287214.R01.S.doc Version 5.1 Page 10 multi-disciplinary team. This has meant that residents who are in their last stages of life are able to remain at the home and be cared for by the home’s staff with any additional support necessary provided by the local medical centre. A GP who came to visit a sick resident during the inspection stated that the home provides excellent care for all its residents and that there was a good working relationship between the medical practice and the home’s staff. At the time of this inspection all the residents living in the home were of British origin and white. They were predominantly of a Christian faith, either Protestant Church Of England or Roman Catholic denomination. At the time of this inspection a funeral was being arranged to meet the religious wishes and beliefs of a deceased resident, and also to uphold the different religious values and beliefs of a relative of the deceased resident. From conversations with staff about this, it was evident that during visits to the home staff were respectful of this relative’s religious beliefs whilst being mindful of other residents living in the home and any impact such different beliefs and values may have on them. Northernhay DS0000003761.V287214.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were inspected at the previous inspection. EVIDENCE: Northernhay DS0000003761.V287214.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 Residents’ legal rights are protected. EVIDENCE: At the time of this inspection Mrs Garland confirmed that all the residents whom have lived at the home since the last Electoral Listing are included on it. Others whom have moved into the home more recently will be added at the next opportunity. In recent elections, Mrs Garland stated that there was a 50:50 ratio of residents whom voted by post and those who were assisted by their families to go to polling stations. Within the home there is information available in leaflet form about “Care Aware” advocacy service. Residents could use this service should they require independent advice and assistance, although at the time of this inspection, Mrs Garland confirmed that most of the residents’ families held enduring Power of Attorney on behalf of their relative. Northernhay DS0000003761.V287214.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 Residents live in well-maintained surroundings with their own possessions around them in their bedrooms. EVIDENCE: Since the last inspection despite a requirement, locks have not been fitted to bedroom doors, or in en-suite facilities because Mrs Garland queried that locks were contrary to the local Fire Safety policy. There was also no documentation on residents’ files to show if residents had been consulted about bedroom door/en-suite locks. In discussion with Mrs Garland about this it was explained that bedroom door locks need to be of a thumbnail style (such as is already fitted in the visitors’/staff toilet), so that they can be easily opened from the outside in case of an emergency. Mrs Garland was also encouraged to consider the possibility of a notice of consent stating personal preference and to be signed in confirmation, being given to each resident (and/or their representative) and then kept on their personal file. Mrs Garland was also encouraged to fit locks to bedrooms as they become vacant so that incoming residents then have a lock and they can choose whether they use it.
Northernhay DS0000003761.V287214.R01.S.doc Version 5.1 Page 14 Since the last inspection Mrs Garland confirmed that the requirement to carry out a Legionella risk assessment had been done. Since the last inspection Mrs Garland confirmed that the requirement to regulate hot water to 43 degrees centigrade had been done with the exception of the top floor bathroom. To ensure that no one used this bath, the tap heads were seen to have been temporarily removed until such time as a suitable valve for a tank-fed water supply can be fitted. Also on the day of this inspection, the bathroom was being used temporarily for storage. Staff confirmed that residents were able and willing to use the other bathrooms as these had assisted bathing facilities. All radiators that are in use and to which residents may have access since the last inspection have been fitted with attractive radiator covers. The radiator in the dining room, for example, was not covered and staff confirmed that this radiator is never switched on and used. Northernhay DS0000003761.V287214.R01.S.doc Version 5.1 Page 15 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): These standards were inspected at the previous inspection. EVIDENCE: Northernhay DS0000003761.V287214.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 36 Staff are appropriately supervised however there is no formal record of any supervision. EVIDENCE: It was evident from observation of all staff that they are competent and adhere to the home’s philosophy of care. All care staff receive appropriate training including fire safety and first aid. Supervision is an ongoing daily process that both staff and Mrs Garland confirmed is at the point of need and not left until a later date. Although the home is registered for up to 18 residents, Mrs Garland prefers to have a lower number of residents to ensure and maintain the familystyle home that Northernhay currently provides. For this reason staff have a close working relationship that pre-empts any issues arising and becoming out of proportion. Staff do not however receive formally recorded supervision it is
Northernhay DS0000003761.V287214.R01.S.doc Version 5.1 Page 17 all practice-based. Likewise, regular staff meetings are held, again informally, and nothing is recorded. Mrs Garland explained during the inspection that there is a possibility of a member of staff starting a NVQ Level 4 in Care and Management. She agreed to consider staff supervision being undertaken as part of the work towards this qualification. Northernhay DS0000003761.V287214.R01.S.doc Version 5.1 Page 18 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 X 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 4 18 X X X X X X 2 3 X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 2 X X Northernhay DS0000003761.V287214.R01.S.doc Version 5.1 Page 19 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 OP24 Regulation 12 Requirement Timescale for action 2 OP24 12((3) 13(4C) 3 OP36 18(2) The Registered Provider must obtain locks for bedroom doors and en- suite facilities that are suitable for use by residents, and accessible by staff in emergencies. These locks must be fitted on the request of the occupant, or when a room is vacated and before it becomes 31/08/06 occupied again. Risk assessments and evidence of consultation with individual residents about having a lock 31/05/06 fitted on their bedroom and/or en-suite doors must be kept on individual residents’ files if locks are not fitted. A record of staff supervision must be kept to evidence that it is taking place and includes 31/08/06 areas such as those mentioned in this standard. Northernhay DS0000003761.V287214.R01.S.doc Version 5.1 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Northernhay DS0000003761.V287214.R01.S.doc Version 5.1 Page 21 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
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