Inspection on 14/11/05 for Obelisk House

This inspection was carried out on 14th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Obelisk House 12/09/06

Obelisk House 16/05/05

Obelisk House 09/12/04

Obelisk House 16/08/04

Obelisk House 11/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Obelisk House Obelisk Rise Kingsthorpe Northampton Northants NN2 8SA Lead Inspector Mrs Pat Harte Unannounced Inspection 14th November 2005 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 Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 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. Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Obelisk House Address Obelisk Rise Kingsthorpe Northampton Northants NN2 8SA 01604 850910 01604 850912 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) Northamptonshire County Council Mrs Frances White Care Home 44 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (44), of places Physical disability over 65 years of age (8) Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. To be able to retain the existing named service user within the category of sensory impairment over the age of 65 years SI(E). No person falling within the OP category can be admitted where there are already 44 people of OP category already in the home. No person falling within the DE(E) category can be admitted where there are already 12 people of DE(E) category already in the home. No person falling within the PD(E) category can be admitted where there are already 8 people of PD(E) category already in the home. To be able to accommodate three named service users who have needs within the MD(E) category. To be able to accommodate one named service user who has needs within the SI(E) category. Total number of service users in the home must not exceed 44. Date of last inspection Brief Description of the Service: Obelisk House is a residential care home providing personal care for up to 44 Elderly Residents, including 12 people with Dementia and 8 people with Physical Disabilities. The Home has additional conditions to be able to continue providing care for 4 Residents who also have Mental Health or Sensory Impairment needs. The Home is owned by Northamptonshire County Council. The Manager is Mrs. F. White. The Home is situated in a residential suburb of north Northampton and is easily accessible by public transport. The premises offer all ground floor accommodation comprising of 4 self contained units with their own lounge dining rooms and bathing and toilet facilities. Single bedrooms are provided for all Residents. There is also a central lounge area at the entrance and a patio garden area. The Home provides for permanent care placements only. Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for Service Users and their views of the service provided. Inspection planning took one hour and consisted of a review of the last Inspection report, previous requirements and recommendations and the Home’s service history including notifications and events. The primary method of inspection used was ‘case tracking’ which involved selecting two Residents and tracking the care they receive through review of their records, talking with them and the care staff. In addition five staff, five Residents and one visiting Relative were spoken with to obtain their views. A partial tour of the premises took place, a selection of records was inspected and observations made on care practices. Discussions were held with the Manager. The Inspection took place during the late morning and afternoon over a period of five hours and was carried out on an unannounced basis What the service does well: The Home has a committed staff group. Residents spoken to felt that their relationships with staff were very good and that staff provided them with good care and support and valued and respected them as individuals. Routines are relaxed and flexible and Residents confirmed that they are enabled to continue with their normal routines, exercise control over their lives and maintain their independence as much as possible. Residents’ health care needs are taken very seriously and a proactive approach is taken to refer any concerns to the relevant Medical Professionals. Meals are varied, well balanced, of good quality, nicely presented and efficiently served. Residents stated that they are given a good choice of options in the daily menu and account is taken of their likes and dislikes and special diets. Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 Page 6 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. Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 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 Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 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): 1, 3, 4 & 5 Prospective Residents are provided with information about the Home to enable them to make informed choice regarding their placement. The pre-admission assessment is effective in ensuring that the needs of People admitted to the Home can be met. EVIDENCE: All prospective Residents are visited and assessed by staff from the Home to ensure that their needs can be met. Residents and their relatives have opportunities to visit the Home prior to admission and are given written information on the services and facilities. Residents spoken with felt that staff were briefed on their overall need and the care to be provided. Staff spoken with felt that they were provided with information on Residents needs, routines and wishes at the point of admission. Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 Page 9 Individual records are kept for each of the Residents and inspection of the records showed that the pre-assessment documentation on physical needs was thorough and included the use of recognised risk assessment tools. Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9 & 10 Care plans do not provide staff with clear guidance and instruction on how the care is to be carried through nor on how Residents with Dementia are to be supported and monitored. EVIDENCE: A complete review of Residents care plans has been carried through with all plans updated to a new format. Two plans were inspected. Whilst improvements were noted to overall content the plans varied and there was a lack of detailed guidance and instruction to staff on how some of the tasks were to be carried through. For example the Resident’s preferred timings for routines such as bathing, getting up and going to bed were not listed. Elements of personal care such as hair care or the continence programme were not detailed. Whilst the Home maintains bath charts in one instance the record had not been completed since the beginning of October. Whilst risk assessments were carried out there were no clear instructions on monitoring of skin conditions. Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 Page 11 The development of Dementia care plans is on going. The plan viewed did not detail clear instructions on how to deal with the Resident’s verbal aggression. The instructions on the management of “wandering” behaviour” referred to half hourly checks only and did not contain written strategies for the management of the behaviour. There were no instructions for staff on how to support the Resident in managing his frustrations and anxieties. The care plans did not detail Resident’s access to their moneys, it is particularly important to instruct staff on whether Resident’s with Dementia are able to have and manage small amount of money, require supervision or assistance or are unable to handle their moneys. Information gathering on Life histories was very limited and was not utilised to assist staff in understanding and working with Residents, particularly those with Dementia. More use could be made of Life Histories in the development of behaviour management strategie. Health care records are maintained and it was clear from discussions with Residents and staff that a proactive approach is taken to ensure prompt referrals to medical professionals. However care should be taken to detail any instructions on the care plans for the monitoring or management of on going conditions. Care planning is an on going area for development, progress to be reviewed on the next Inspection. The Home’s medication system and records were inspected. In one instance the prescription details for the pain relief medication for a new Resident had not been written correctly on the Administration record. The Prescription stated the medication was to be given as required but the Administration record stated that two tablets were to be given four times a day. The maximum daily dosage was also not stated. In another instance there were no instructions for staff on the circumstances in which they should administer a sedation medication. These areas were discussed with the Manager who agreed to ensure written protocols are in place for PRN medications where necessary to guide staff on their usage and to ensure care is taken to accurately transfer prescription details. The mid day medication round was safely carried through. Medication storage was appropriate. Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14 & 15 Residents are enabled to exercise choice in the way they wish to lead their lives and their preferred routines were respected and upheld. EVIDENCE: Residents felt routines were relaxed and flexible and that their preferences on rising and going to bed times were respected. They felt that they were free to decide on how and where they wished to spend their time. They stated that they were kept informed of the Home’s general activity programme and were free to take part or not as they wished. Residents felt that the currently staffing difficulties and the high use of Agency staff to fill rotas were affecting the activity provision. Attention is being paid to the development of individual, meaningful activities for Residents with Dementia although on the day of inspection no structured activities were taking place and no individual programmes were in place. This is an area for ongoing development. A number of Residents were spoken to and everyone who commented on the food said they had choice and their special and likes and dislikes were catered Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 Page 13 for and respected. They felt that they were provided with choice and that staff ensured alternatives were always available to tempt their appetites. Improvements have been made to the serving of the midday meal. Observations confirmed that Staff ensured Residents were quickly and efficiently served. Residents were assisted with their meals where necessary and specialist cutlery and equipment was provided. The Home has an open visiting policy. Residents confirmed that they were enabled to see their visitors in private if they wished. One visiting Relative commented that she was always made welcome and extended hospitality. She felt that she was kept informed of the progress of her Residents and that staff made time to discuss any areas of concern. Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Systems are in place to protect Residents from abuse and to ensure that complaints are listened to and acted upon. EVIDENCE: Residents confirmed that they had been given the Home’s complaints procedure which is also displayed in the Home. They felt confident and able to raise any issues or concerns with staff. A complaints record is maintained showing that each complaint is taken seriously, investigated and action taken to resolve the issues. No complaints have been received by the CSCI in the last year. The Home has a procedure for the Protection of Vulnerable Adults. Staff spoken with had received training on Elder Abuse and showed that they would react quickly and appropriately to any allegations. Senior staff have responsibility for the reporting procedures to the Authorities. Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 Page 15 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): Residents are provided with a well-maintained and homely environment but the garden areas remain potentially hazardous. EVIDENCE: Attention has been paid to improving the general maintenance of the premises. Previous requirements relating to maintenance and redecoration issues have been met. The general security of the Home has been improved with the addition of perimeter fencing and all exit doors in the dementia care unit are alarmed to alert staff for safety reasons. There remains however a potential risk that Residents can leave the building unnoticed through the front door but work is planned to provide a keypad lock to reduce the risk. The garden areas remain problematic and present dangers and hazards. An Occupational Therapist has visited the premises; the Manager confirmed that she has identified similar hazards raised by the Commission in the Inspection report dated 16th May 2005. For example the paving to the central patio area is Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 Page 16 uneven and drainage gullies run through the centre creating trip hazards. Ramp exits from some Lounges and fire escape doors are hazardous. At least two ramps to the patio area are very steep, no handrails were provided. Ramps from fire exist doors lead directly onto grass areas some ramps have a drop of two or three inches onto the grass, there are no pathways around the Home. Staff have expressed concerns that it would be very difficult to push wheelchair users away from the building should this be required in an emergency and that the ground is uneven and hazardous should residents access these areas. The service area by the side of the kitchen is potentially accessible to Residents. This area contains bins and other rubbish and low hanging washing lines. The Manager stated that this area is to receive attention shortly. Advice was given that the area should be fenced off for complete safety. Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 29 The consistency and continuity of care of the Residents is currently affected by the high use of Agency Staff to fill the rotas, some Agency staff do not have the necessary training in understanding the needs of and to provide care to Residents with Dementia. EVIDENCE: Residents spoken with said that the staff were very kind, committed and caring. However some Residents and a visiting Relative commented on the increased reliance on the use of Agency staff to cover staff rotas. They felt that this affected the continuity and consistency of care and Residents said they constantly had to get to know new faces and develop relationships. The staffing rotas showed that where possible 6 care staff were deployed on the morning shifts with 5 on duty in the afternoons. 3 Carers provide night care. On the day of Inspection the afternoon rota consisted of 3 permanent care staff and 2 Agency carers. The Agency staff members spoken with confirmed that they had received induction. Whilst the process was viewed as thorough regular staff stated that the constant changes in Agency staff placed time constraints on them to inform, guide them in what to do. Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 Page 18 It was clear from discussions with the Agency staff that they did not have the necessary training in understanding the needs of and providing care for Residents with Dementia. Observations showed that the Agency staff needed constant direction and supervision, which placed further time constraints on permanent staff and detracted from their work with other Residents. Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32 & 35 The systems for the management and safekeeping of Residents moneys were not safely and appropriately maintained. EVIDENCE: Residents felt the Manager was readily available to them. They commented that regular Residents meetings were held and that the Manager also sought their individual views. Residents felt that they had trust and confidence in the staff group as a whole. Staff spoken with felt that the Manager was easily accessible to them and was willing to discuss any issues and guide them in practice. The systems for the management of Residents finances and the safekeeping of valuables have revised but care needs to be taken to maintain receipts for all Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 Page 20 transactions for example receipts were not maintained were a resident had purchased a cream tea. Staff did not sign all the transaction records. The Home’s fire maintenance records indicated that due attention was paid to the testing of the equipment and that staff were provided with fire safety training and fire drills were regularly carried out. Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 Page 21 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 2 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 2 X X 3 Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 Page 22 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 OP22OP19 Regulation 23.(2) (o),13(4) (a) Requirement The Registered Provider is to submit an action plan detailing proposals and timescales for making the garden areas and exit ramps safe for Resident access in accordance with the recommendations made by the Occupational Therapist. Timescale for action 31/12/05 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 27 Good Practice Recommendations Staffing availability should be addressed to reduce the usage of Agency Staff to ensure continuity and consistency of care for Residents. Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Obelisk House DS0000035721.V262799.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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