CARE HOMES FOR OLDER PEOPLE
Northernhay Townstal Pathfields Dartmouth Devon TQ6 9HL Lead Inspector
Fiona Cartlidge Unannounced Inspection 31st May 2007 10:15 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.V335582.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. Northernhay DS0000003761.V335582.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Northernhay Address Townstal Pathfields Dartmouth Devon TQ6 9HL 01803 833964 01803 835186 office@northernhaycarehome.co.uk 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.V335582.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21/03/06 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. The accommodation is provided on three floors. The first floor is accessed via a passenger lift and the lower ground floor by a stair lift. On the ground floor there are a lounge, 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 home has attractive gardens to the front. 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. Information about the home including a copy of the last inspection report can be obtained on request from the administration office. Information in the guide to the home and the brochure indicates the current range of fees is from £425 to £525/week. Additional charges are made for chiropody, hairdressing, optician, dentist, dry cleaning, escorted trips to appointments etc and toiletries. Northernhay DS0000003761.V335582.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The site visit took place over 4 hours and was unannounced. A partial tour of the home took place when some bedrooms and all communal areas were viewed. Two residents had their care case tracked this means their records were examined in detail and these residents were spoken to in depth about the care and services they receive. Five other residents were spoken with during the visit, two members of staff, a visiting health care professional and the registered manager/provider. Personnel records of 2 members of staff and policies and procedures were also inspected. 6 residents, 9 relatives/visitors and six members of the homes care staff retuned surveys. What the service does well:
People who use this service have sufficient information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that people’s needs are identified and planned for before they are offered permanent residency at the home. People who use this service are provided with a good level of health and personal care and, they are protected by the homes policies and procedures for medicines. Comments from people living in the home include ‘I am very satisfied with the service I receive and I am confident that when I feel ill there is someone on hand to help me and we get top help from the district nurses’. People who use this service enjoy a peaceful, pleasant yet varied life, with family and local community links maintained and encouraged. Various formal and informal impromptu activities are made available on a regular basis. Good quality meals are provided. Comments from people living in the home included, ‘David the chef here cooks lovely meals, the atmosphere throughout the house is so uplifting and helpful’, The people living in the home said they were happy with the visiting arrangements, visitors said they feel welcomed into the home and are able to visit their relative/friend in private or socially. Comments from family/visitors included: ‘always friendly, can ring any time, helpful with medical problems,
Northernhay DS0000003761.V335582.R01.S.doc Version 5.2 Page 6 keep me up to date, nothing seems too much trouble, I have been delighted with my mothers care’. The environment is clean, warm, safe and comfortable. All of the Residents spoken to were satisfied with their private accommodation and there was evidence that they are able to bring personal items with them into the home. Staff at the home are well trained and supported, and employed in sufficient numbers to meet the residents’ needs at all times. Comments we received included: ‘ all the staff and management are so helpful and caring’ ‘my mother has found patience, understanding and support, she doesn’t wish to be anywhere else’. Although the home is registered for up to 18 residents, the registered manager/provider The care staff also receive formally recorded supervision, which is practice-based and supportive. Likewise, regular staff meetings are held, and minutes are recorded. 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
Northernhay DS0000003761.V335582.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. Northernhay DS0000003761.V335582.R01.S.doc Version 5.2 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 Northernhay DS0000003761.V335582.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have sufficient information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that people’s needs are identified and planned for before they are offered permanent residency at the home. EVIDENCE: The home has a written guide/statement of purpose this document sets out the aims and objectives of the home and provides information about the service. This and a simpler guide (brochure) were available for inspection and can be requested from the homes administration office. Northernhay DS0000003761.V335582.R01.S.doc Version 5.2 Page 10 The personal records of 2 Residents were seen in detail these Residents were then spoken with about their experience of living at Northernhay these Residents confirmed that the home was exceeding the expectations they had when they were admitted. One Service User said that a professional representative had chosen the home because they themselves had been too poorly this resident told us they were pleased with the decision and never wants to leave the home for two main reasons; Its calm atmosphere and Christian ethos. Another residents told us they chose Northernhay because of its good reputation in the local community and because of its proximity. Both confirmed that the home had done an excellent job in meeting their needs. An assessment of care needs of prospective Residents takes place prior to admission to the home. Documents seen provided evidence that the home uses a standard assessment form; this assesses prospective Residents needs and allows the homes personnel to make a clear decision about whether or not these needs can be met. Other records seen included copies of assessments carried out through care management arrangements and hospital/community health care teams where applicable. All residents are admitted on a month’s trial period for on going assessment before being offered permanent residency. This ensures the home is able to meet the individuals needs fully and also that the resident is happy to stay and fit into the small community. This home does not provide intermediate care. Northernhay DS0000003761.V335582.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service are provided with a good level of health and personal care and, they are protected by the homes policies and procedures for medicines. EVIDENCE: Residents spoken with confirmed they receive a good level of care. Personal records held on behalf of 2 Residents were examined; in both of these there were documented assessments that provided information about skin integrity, moving and handling and safety - including risk of falls. The information generates the plans of care, which provide the basis for the care to be delivered. The plans of care are held in the office, resident’s spoken to in detail were aware of the documentation held on their behalf. Northernhay DS0000003761.V335582.R01.S.doc Version 5.2 Page 12 The plans had been regularly reviewed and updated to reflect changing needs. Staff use these records to inform them about how to meet peoples care needs. Records are maintained for all visits to the home by social or health care professionals, all Residents are registered with a GP. Records provided evidence that as well as visits from General Practitioners, district nurses and chiropodists visit. Records of outpatient appointments show that visits to community and hospital health resources are enabled. Information provided by a visiting health care professional was extremely positive we were told that the home is the ‘best’ in their opinion. A general practitioner also visited at the time of our visit communication with the homes staff was observed to be professional and respectful and the consultation took place in the privacy of the residents’ own room. The medication system is generally well managed, to date records have not been maintained of whom, when and how many medicines are received into the home. The care manager said this had been identified as a requirement in a teaching session they had received from their supplying pharmacist the day before our visit and that a decision to include this safe practise would be introduced as part of the homes medication procedures. The medication administration records did have some gaps; where topical (creams and lotions) medication had been prescribed there was no record of their administration and it was not clear therefore whether medication had been administered or not. This poses a risk to people who use this service because there is no clear record that they have or have not received their treatment, which may lead to under or over administration. Staff were seen and heard knocking on doors before entering rooms and were carrying out personal tasks in private. Staff observed in conversation with residents were heard to be courteous and respectful. Northernhay DS0000003761.V335582.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service enjoy a peaceful, pleasant yet varied life, with family and local community links maintained and encouraged. Various formal and informal impromptu activities are made available on a regular basis. Good quality meals are provided. EVIDENCE: During the site visit, some residents were seen sitting in the lounge in conversation with each other, staff and visitors, some were reading newspapers and residents joined together in completing a crossword. Other residents were seen spending time in their rooms, reading, listening to music, or watching television. Staff were consistently seen during our visit encouraging and enabling residents to engage in meaningful conversation.
Northernhay DS0000003761.V335582.R01.S.doc Version 5.2 Page 14 The records seen did not contain information about people’s life experiences their interests or hobbies. Organised activities are advertised on a notice board in the entrance hall. A notice advertised a clothes sale to be held the following week. There were no organised activities on the day of our visit. At the time of our visit all the residents living in the home were of British origin and white. They were predominantly of a Christian faith; People told us that they are able to attend church services both within the home and in the local parish. We were told that residents like to sit and watch songs of praise together on Sundays and that they sing along with hymns they know. The feedback about food was positive all of the residents spoken with said how good it was; some residents ate lunch in the lounge/dining room others ate their lunch in their own accommodation. The food served at lunchtime looked appealing. Cold meat was served with a seasonal salad, we were told by residents this had been changed on their request to replace liver and bacon, which had been served during the winter months. The home does not currently advertise a choice of menu at each mealtime, however residents said they had been asked their likes and dislikes and the chef never gave them what they didn’t like. The people living in the home said they were happy with the visiting arrangements, visitors said they feel welcomed into the home and are able to visit their relative/friend in private or socially. Northernhay DS0000003761.V335582.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for protecting people who use this service and responding to their concerns are satisfactory. EVIDENCE: This service has a complaints procedure it is clearly written and easy to understand and was seen advertised in the guide about services as well as displayed as a notice in the entrance hall. Residents and visitors confirmed that they felt comfortable discussing issues with the staff and manager. There have been no complaints referred to the Commission about this service. Records seen show that the Staff are made aware of and attend training on the recognition and reporting of incidents or allegations of abuse or neglect, all 6 staff who returned surveys to us indicated they are aware of adult protection procedures. The guide to the home includes information for residents on how to contact the ‘Care Aware Helpline’. Residents said they feel safe living in the home. Northernhay DS0000003761.V335582.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is clean, warm, safe and comfortable. EVIDENCE: A tour of the building showed that some areas of the building have been redecorated but in some areas including the dining room the job had not been completed. In the lounge we noted Christmas decorations were still in place and noted these were concealing wires coming through the ceiling and down one wall. All of the Residents spoken to were satisfied with their private accommodation and there was evidence that they are able to bring personal items with them into the home. Northernhay DS0000003761.V335582.R01.S.doc Version 5.2 Page 17 The home benefits from 3 communal rooms as well as attractive and accessible gardens. There is a range of equipment around the home, available to assist staff in moving and handling residents, as well as hand washing facilities and disposable gloves and alcohol rubs for use when/if in contact with body fluids. The environment was clean and odour free at the time of the visit. Northernhay DS0000003761.V335582.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff at the home are well trained and supported, and employed in sufficient numbers to meet the residents’ needs at all times. EVIDENCE: Two Personnel files were examined, these records generally showed a commitment to safe recruitment practises, files contained detailed Curriculum Vitaes, 2 written references, work visas and international criminal record checks, and each file held proof of the person’s identity. Training and development records provided evidence that training is provided and ongoing. All 6 staff who returned surveys to us indicated they receive sufficient training to enable them to meet the needs of those living in the home. All new members of staff have to work through induction standards. The residents were extremely complimentary about the staff team confirming their needs were met 24 hours a day. Comments received from clients
Northernhay DS0000003761.V335582.R01.S.doc Version 5.2 Page 19 included: ‘I am really impressed with the care and support that I am given here at Northernhay’, ‘the staff are kind and attentive’, ‘as soon as you ask the staff for something you get it’. ‘the staff can’t do enough for us’. Northernhay DS0000003761.V335582.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Northernhay continues to be managed well and run in a safe way, which also takes into account the best interests of residents. EVIDENCE: It was evident from observation of all staff that they are competent and adhere to the home’s philosophy of care. There are clear lines of accountability Mrs Garland is both the registered manager and provider and Mrs Padden is care manager in charge of managing the small team of care assistants. Northernhay DS0000003761.V335582.R01.S.doc Version 5.2 Page 21 The staff have a close working relationship that pre-empts any issues arising and becoming out of proportion. The care staff also receive formally recorded supervision, which is practice-based and supportive. Likewise, regular staff meetings are held, and minutes are recorded. 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 family-style home that Northernhay currently provides. Thirteen residents were living at the home at the time of this inspection. The home’s quality assurance system includes a questionnaire being sent out annually to stakeholders to ensure that a continual form of self-monitoring takes place. We were shown the recently retuned surveys the responses were mainly positive and communicated a high level of satisfaction the only suggestions for improvements were: ‘trips out would be nice’ and ‘an increased choice of food and higher standard of catering’. The staff in this home do not manage personal money on behalf of residents. We were shown that any sundry items provided above and beyond the expenses detailed in the terms and conditions of residency are invoiced directly to the resident or their representative. A tour of the premises showed that the home’s health and safety was in order Fire safety notices were displayed and training records show that staff have regular training on fire safety, first aid and safe moving and handling. There was a record of all accidents/incidents and Residents who have a consistent number of falls are referred to the falls pathway team for further professional assessment. Northernhay DS0000003761.V335582.R01.S.doc Version 5.2 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 3 Northernhay DS0000003761.V335582.R01.S.doc Version 5.2 Page 23 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. 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 Refer to Standard OP9 Good Practice Recommendations When topical medication (creams and lotions) is administered to people who use this service it should be clearly recorded. This will ensure that people receive the correct levels of prescribed medication. There should be choice of menu at all meal times, which is given, read or explained to the residents. 2 OP15 Northernhay DS0000003761.V335582.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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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