Inspection on 31/03/08 for Ocean Swell

This inspection was carried out on 31st March 2008.

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

Ocean Swell 26/01/07

Ocean Swell 11/10/05

Ocean Swell 27/06/05

Ocean Swell 17/03/05

Ocean Swell 24/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Ocean Swell Ocean Swell 33 Sea Road Westgate-on-sea Kent CT8 8SB Lead Inspector Jenny McGookin Unannounced Inspection 31st March 2008 09:40 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 Ocean Swell DS0000023511.V359393.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. Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ocean Swell Address Ocean Swell 33 Sea Road Westgate-on-sea Kent CT8 8SB 01843 832362 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) oceanswellcare@btinternet.com Mr Martin Stephen Rose Mrs Denise Elaine Mary Rose Mrs Denise Elaine Mary Rose Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (17), Physical disability (15) of places Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The total number of residents shall not exceed 32. Residents who are physically disabled must be over 35 years of age. To admit one (1) Service User, whose date of birth is 14/05/1920. Date of last inspection Brief Description of the Service: Ocean Swell provides residential care for up to 17 older people and 15 people with physical disabilities, who require varying degrees of assistance. The home comprises of a large detached premises with coastal views and is located within short distances of the seafront, local shops, post office, library and public transport links. The home is a family run business, with the owners having a high level of input into the day-to-day running of the home. A team of care staff and domestic staff are employed, this includes two waking night staff. Accommodation briefly comprises of a large lounge, dining room with open smoking room, off road parking and an enclosed garden. Bedrooms are located on the ground, first and second floors with lift access to all floors. Fees are: £303.29 - £429.12 per week. Additional charges are made for: medical requisites obtained by private prescription, chiropody, hairdressing, newspapers, clothing, dry cleaning, toilet requisites and other items of luxury or personal nature, charges for meals or accommodation for visitors, and connection of personal phone. Information on the Home’s services and the CSCI reports for prospective service users should be detailed in the Statement of Purpose / Service User Guide. The e-mail address for this home is: ocdeanswellcare@btinternet.com Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced site visit, which was used to inform this year’s key inspection process and to check on any developments since the last available inspection report (January 2007), given all the timeframes had run their course. The inspection process took nine and a half hours. Both proprietors (including the registered manager) were on annual leave on the day of the visit. In their absence, the inspection involved meetings with two residents (over lunch), and four others individually during a tour of the building; the deputy manager and the home’s founding proprietor, as well as the home’s activities co-ordinator (who is also the daughter of the proprietors), and two visiting professionals (Community Health Care Assistant, and the exercise physiotherapist. Interactions between staff and residents were observed throughout the day. The inspection also involved the examination of records and the selection of two residents’ case files, to track their care. The home had submitted an Annual Quality Assurance Assessment (AQAA) in advance of the site visit, as required. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. This was judged a well written, comprehensive account of the issues raised, which reflected provision fairly. A selection of feedback questionnaires was taken to the inspection for distribution to residents and other stakeholders, and several were submitted in time to be taken into account in this report (five residents, five staff and two healthcare professionals). Account was also taken of the home’s own recent quality assurance feedback exercises from March 2008 (sixteen residents, and fifteen visiting relatives and friends). Nine bedrooms were inspected for compliance with the National Minimum Standards on this occasion, along with communal areas / facilities. What the service does well: The location of this home is judged attractive, with panoramic sea views and wheelchair access to beachside gardens and café facilities. It is close to Westgate-on-Sea town, with all the community and transport facilities that implies, and it’s onsite parking and unrestricted kerb-side parking are convenient for visitors. Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 6 This home suitable for its existing registered purpose, and a very satisfactory level of compliance with the National Minimum Standards is being maintained throughout the property and site. All areas of the building inspected were well decorated and furnished, clean and odour free. Staff are to be commended. Records indicate that the health and personal care needs of the residents are generally adequately provided for. There is input from a range of healthcare professionals and some evidence of equipment and adaptations throughout the home. There appear to be sufficient management and staffing resources in place to keep people safe. The residents benefit from two dedicated chefs, and meals tend to be traditional English home cooking. There is a choice of meals and some special dietary needs can be catered for. The standard of catering was judged one of this home’s key strengths. This home is generally viewed very positively by those using its services. Residents are consulted and are afforded choices on a day to day basis. What has improved since the last inspection? The information provided in the home’s AQAA combines with other information received by the Commission and this inspection’s findings, to show that all the matters raised for attention at the last inspection have been addressed, indicating that good use is being made of the regulatory sector. The AQAA reports that the external aspect of the building is undergoing refurbishment, and the variety of meals has been increased, as a direct consequence of listening to residents. Employees are no longer required to retire once they reach sixty five years of age, and their retention is further encouraged by opportunities to work reduced hours to suit. Copies of care managers’ assessments are being more robustly obtained as part of the residents’ admission process, and information gathering (at initial assessment stage, care planning and in daily reports thereon) is more detailed and demonstrably inclusive in terms of scope for recording feedback. The AQAA also reports that the medication arrangements have been completely reorganised. There is a rewritten policy, underpinned by staff training, better storage facilities and record keeping. An activities co-ordinator has been appointed, to increase the range and frequency of activities. And records are sufficiently detailed to enable anyone authorised to inspect them to evaluate the take-up by individuals. Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 7 The AQAA reports that communication between the residents and staff has been improved by the introduction of a Comments Book, for positive and negative comments. A smokers’ room has been set up at one end of the dining room, and is properly segregated and ventilated to prevent dining facilities being affected. Several areas of the home have been refurbished (five bedrooms, dining room and smokers’ room, plus two ground floor WCs. And the wheelchair accessible shower room on the ground floor has been upgraded. All unguarded radiators have been replaced with low-surface-temperature models, and water temperatures are being checked. Infection control procedures have been improved – all of which will help ensure people keep safe. The AQAA reports that the number of care hours has been increased by 28 hours a week, and the number of non-care hours has been increased to enable care staff to concentrate on their core duties. Induction of new staff have been brought in line with “Skills for Care” specifications and police checks (POVA 1st and CRB) have been tightened. Finally, the AQAA reports that feedback questionnaires have been distributed to resident, their relatives and staff. Data Protection principles have been applied more robustly to record-keeping, and financial transactions have been further safeguarded by a system of counter signatures and subject to formal auditing. 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. Ocean Swell DS0000023511.V359393.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 Ocean Swell DS0000023511.V359393.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 1, 2, 3, 4, 5, 6 Prospective residents and their representatives can have almost all the information needed to decide whether this home will meet their needs. Prospective residents have their needs assessed and a contract which clearly tells them about the service they will receive. EVIDENCE: The home has a Statement of Purpose and Service User Guide, each of which usefully provides a range of information on the home, its principles of care and its facilities and services. But throughout the text the reader is referred to a range of separate documents, which would need to be requested to obtain the full picture. Both documents are written in plain English, and a statement on page 5 of the Service User Guide states that senior staff can be asked to assist with reading the contents. Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 10 No other languages are currently warranted – all the residents are British. The home has a checklist to evidence the issue of information, but it does not specify what this entails or whether other languages or formats (e.g. tape or large print) were warranted. This is recommended. The Service User Guide has been amended since the last inspection, but the Statement of Purpose provided dates from 2005 and some details may need updating. A few minor matters still require attention in respect of both these documents, to obtain full compliance with all the elements of the National Minimum Standards, so that the home can be fully confident that prospective residents and their representatives have all the information they should have to make an informed choice of home. The detail has been reported back to the home separately. The residents spoken to on this occasion were able to recall different elements of their preadmission process, though in most cases this was arranged by relatives or professionals (social or healthcare), so as to be close to where they or their relatives lived. One resident recalled seeing the home whenever she went on cliff top walks. All expressed content with the choice of home made, accepting they could no longer cope with living in their own homes. Records confirm that an assessment of needs is carried out before each admission, which records confirm that they would also take into account assessments and care plans set up either by the relevant funding authority or by other providers, and are developed thereon. There are opportunities for residents or their representatives to visit the home before admission to assess its suitability for themselves, and there is a 4weeks’ trial stay. Each admission is confirmed by a contract. The home’s contract was largely compliant with the element of the National Minimum Standards. Some minor recommendations were reported back to the home separately, and were addressed. This home does not provide intermediate care. See sections on “Environment” and “Health and Personal Care” for findings in respect of the home’s capacity to meet the needs of its residents. Ocean Swell DS0000023511.V359393.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 7, 8, 10 The health and personal care, which a resident receives, is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Two residents’ files were selected for case tracking on this occasion, to represent admissions over the past year, and these were followed through with discussions with residents (where they were able and willing), visiting professionals and feedback questionnaires (the Commission’s and the home’s own). Each resident has a plan of care based on the home’s initial preadmission assessment and assessments by funding authorities. These outline general background information, including information on social contacts and Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 12 relationships and the likelihood of their involvement; as well as assessments of a range of daily living needs. These detail the exent to which residents can self care. The care plans generate action sheets designed to instruct care staff, to ensure that the health and personal care needs of the residents are addressed. However, the level of detail seen varied between good practical person centred instruction and generic instruction which would have universal application. Record is being kept of contact with healthcare professionals, and a meeting with a visiting Community Healthcare Assistant who had been visiting the home for the past 19 years indicates that communication has been good and that issues such as pressure area care were being managed well. When asked how this home compared with others, she said “this is one of the better ones”. Feedback from a Community Nursing Sister endorsed this, by saying the home always sought advice and acted upon it to manage and improve individuals’ health care needs. “Care is adjusted to clients’ needs – updated on a regular basis”. A chiropodist said that any follow up care needed after treatment was always carried out, and that if care needs could not be fully met, the residents were always referred on. The quality assurance feedback exercises carried out by the Commission and the home confirmed a sound level of satisfaction with the level of care given. Clearly practice has been meeting the expectations of visiting healthcare professionals as well as residents and their relatives. Less evident, however, were cross-references within records (such as daily reports, care plans) to other records or risk assessments, generic or specific - covering the individuals, their behaviour, activities and their environments. This would enable anyone authorised to inspect the records to track people’s care. It was not clear, moreover, to what extent residents or their relatives / representatives are actively engaged in the care planning reviews, except in respect of reviews carried out by care managers. Neither of the files selected for case tracking contained a formal review carried out by the home to include interested parties. None of the residents spoken to on this occasion were familiar with the care planning process, though they each recalled being asked questions about their care on a day-to-day basis. Care plans are supplemented by daily reports, which would have shown an overwhelming bias towards health and personal care issues, except that since the last inspection, they have been supplemented with detailed reports from the activities co-ordinator to give a sense of lifestyle (see section on “Daily Life and Activities” for more details. Interactions between staff and residents were observed throughout the visit and were judged appropriately familiar and respectful. No poor practice was observed. Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 13 With six exceptions, all the bedrooms in this home are single occupancy, which means health and personal care can be given in privacy. Residents confirmed that the daily routines are as flexible as healthcare needs and staffing levels will allow. Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 14 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 good This judgement has been made using available evidence including a visit to this service. 12, 13, 14, 15 Residents are able to choose their life style, social activity and keep in contact with family and friends. Social, cultural and recreational activities meet resident’s expectations. Residents receive a healthy, varied diet according to their assessed requirement and choice. EVIDENCE: The residents spoken to on this occasion were not able to give many examples of any particular interests or hobbies being actively promoted by the home, but they all said they were generally very content. And staff said a few of them had been disinclined to join in any activities offered. Since the last inspection, the proprietors’ daughter has assumed the role of activities co-ordinator, and she collects information from the local library on events likely to interest the residents as well as regularly asking them what they would like to do directly. There is an activities programme on display, Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 15 which is applied flexibly, and each resident has a sheet documenting what they’ve done that day, so that their social care needs can be tracked and evaluated, even where their own recall is poor. Examples included: “Sit and Keep Fit” sessions led by a visiting exercise physiotherapist and/or staff, outings, arts and crafts, painting, Bingo, giant dominoes, skittles, board games, and sing-a-longs (including the playing of instruments). An organist comes in on alternate Sundays and there is a DVD and book library on site. Or residents can access the games cupboard for themselves. There are shopping trips to Westgate and Margate, and residents eat out. One resident told us “I enjoy the bowling trips”. Another said “I like playing dominoes”. One resident goes to Shaw Trust for activities (computers, painting) and for support to help him get employment. One likes to go to his favourite band’s concerts. One other likes railways so for his birthday they will be going on a train to Broadstairs, where he was brought up. One resident “likes gardens so we arranged that”. Another likes books and goes to the library regularly. A hairdresser comes in regularly, and there is a visiting chiropodist. The activities co-ordinator can provide one-to-one support but said “I do always invite the others to join us and I can repeat visits to accommodate all those who want to go”. Where the group involves wheelchair users as well as people able to walk, staffing levels are adjusted to accommodate this – one outing can commit three staff at a time. Residents are able to have visitors at any reasonable time. The home is reasonably well placed for links with the local community (see also section on “Environment”). There is a communal payphone on the ground floor outside the office, and residents can have lines installed in their own bedrooms, at their own expense. Unless other arrangements have been made, residents receive their mail unopened. Catering needs are properly identified as part of the preadmission process and updated or amended thereon. Feedback from the residents in the home’s own recent quality assurance survey indicates a sound level of satisfaction with the meals (nine rated it “very good”, five rated it “good” and one rated it “satisfactory”). The Commission’s own survey endorsed this. One resident’s criticism that the Sunday tea-time options were becoming boring, were addressed. The inspector joined two residents for lunch on this site visit and judged the meal well prepared and well presented. The residents confirmed this was representative, and that alternatives were readily available. The pace was unhurried and congenial. Residents confirmed that they were offered sufficient snacks between meals, and that hospitality was extended to their visitors. Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 16 The dining area is a curiosity because it is set up rather like a commercial diner with a number of fixed oblong tables set at ninety degree angles along opposite walls, each with its own pair of fixed soft bench seats, so as to create discrete bays. The room has been refurbished since the last inspection and provides a pleasant enough setting. There are framed pictures down two walls, though the covering of one other wall with framed staff training certificates may detract from its homeliness. One end has been partitioned off to create a separate smoker’s room – this is separately heated and ventilated so as not to interfere with the atmosphere in the dining area. Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 17 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 This judgement has been made using available evidence including a visit to this service. 16, 17, 18 Residents are welcome to access to the home’s complaints procedure. Residents are protected from abuse and have their legal rights protected. EVIDENCE: This home’s Statement of Purpose properly includes an undertaking to welcome complaints and refers the reader to a selection of separate relevant policies for the detail (i.e. on “comments, suggestions and complaints”; “confidentiality” and “access to records”). The need to request a copy would, however, draw attention to a prospective complainant which some might find off-putting. The owner/manager will need to remove its reference to the CSCI as the lead agency, now that social services have assumed this role. Information supplied by the home’s AQAA indicated that no complaints had been registered over the past twelve months, and none have been received by the Commission. This is not usually judged a realistic reflection of communal living, but for the sound level of confidence expressed by residents and relatives in their feedback in raising any concerns they might have, and their satisfaction with the care they receive. Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 18 The deputy manager said that no independent advocacy services are currently being used to support the residents. Residents would need to rely on relatives or staff to represent their interests, where they are not able to do this for themselves. A directory of local advocacy services would be judged good practice. Records confirm that postal voting is being arranged, and one resident is said to correspond with his local MP. The last inspection established that the home has on the protection of the residents, to ensure a timely and co-ordinated approach, should an incident arise. Feedback from staff confirmed their commitment to report any instances of adult abuse. Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 19 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. 19, 20, 21, 22, 23, 24, 25, 26 The physical design and layout of the home enables residents to live in safety. Residents benefit from a well-maintained and comfortable environment, which generally encourages their independence. EVIDENCE: There are good bus and train links within five minutes’ walk of the entrance of the site of this home, linking it to Margate, Birchington, London etc – with all the community and transport links that implies. The front is dominated by a forecourt, which can accommodate up to three vehicles, though it tends to be used as a patio area for tables and seats in good weather. There is unrestricted kerb-side parking on the road outside. There is level access from the outside pavement onto the forecourt and a ramp Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 20 to the front door. The front door has key-pad access to prevent unauthorised access, but a number of residents know the code and use it regularly. The garden at the back is L shaped and provides a reasonably level surface, with a very high wall along one boundary. A greenhouse was removed to create a small patio area alongside one lawned stretch. No residents currently show any interest in gardening but the home does have one fruit tree (a second has died and will require removal) and there is a raised bed, should they wish to. All areas of the home inspected were found to be comfortable, clean, adequately lit and maintained at comfortable temperatures. All radiators now have guards or low surface temperatures (matter raised for attention at the last inspection), to keep people safe. The furniture tends to be domestic in style. There were homely touches throughout. All the bedrooms, bathrooms and WCs seen had accessible call bells. Accommodation is arranged over three floors. A shaft lift provides access to all floors. There is a range of equipment and adaptation available in this home e.g. wheelchair accessible WCs, shower and bathrooms, grab rails, handrails and hoisting equipment, slide-mats. Residents would have access to their own wheelchairs, Zimmer frames and other mobility equipment. When asked, the deputy manager said that there is no Loop system for use with hearing aids. However, there have been no overall periodic audits by specialists such as Occupational Therapists. This is strongly recommended, to ensure the home maintains its capacity to meet the needs of its residents. Residents currently have some choice of communal areas. There is one main lounge area, a smokers’ room and a dining room. See section on Daily Life and Social Activities for details on telephones and contact with families and friends. This home has 19 bedrooms registered for use as single occupancy and six bedrooms registered for use as potential double rooms. The bedrooms in this home vary considerably in size, and 18 would not be suitable for use as bedrooms if this were a new registration, but for exemptions that apply to registrations of long standing. 15 single occupancy rooms are below 12 sq. metres (the current National Minimum Standard), and 4 of those are below 10 sq. metres. 3 double rooms are below 16 sq. metres (the current National Minimum Standard). Nine bedrooms were selected for inspection and judged in a generally good state of decoration and maintenance. Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 21 Seven did not, however, have the requisite number of electrical sockets, so residents may need to rely on multi-socket extension leads to operate electrical appliances, and their siting close to floor level would mean residents having to bend or summon help to use them – three foot above floor level is the recommended height for older people or people with disabilities. Four of the bedrooms inspected did not a table for residents to sit at; three did not have a second comfortable chair e.g. for visitors (in one case there would be no space for this); and three did not have lockable space for residents to store items of personal value to them. The reader is advised that this is only acceptable if non-provision can be justified by documented risk assessment or consultation. Some commodes were obvious institutional models, which would signal incontinence to any one entering the room. More discreet models would accord residents more dignity. This home has WC and bathroom or shower facilities on all floors i.e. reasonably accessible to all the bedrooms and communal areas, so that residents have some choice. Nine bedrooms have their own en-suite WCs and wash hand basins (and in three cases their own bath), so that privacy can be guaranteed for their occupants’ personal care. The three washing machines in this home have sluice cycles and there is a separate sluice room. Continence appears to be managed adequately at this home. There were no unpleasant odours. See schedule of recommended action for matters requiring attention or consideration. Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 22 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 This judgement has been made using available evidence including a visit to this service. 27, 28, 29, 30 Staff in the home are trained, skilled and in sufficient numbers to fill the aims of the home and meet the changing needs of residents. EVIDENCE: The inspector understands the following staffing arrangements apply, based on a working / waking day of 14-hrs - from 8am to 10pm • 8-3: 4 care staff plus manager (usually) • 3-6: 3 carers (one of whom also works in the morning i.e. deputy or head of care. There is someone senior on duty all day. • At night (10-8) there are two carers on waking duty, with a senior on call, or the deputy of head of care • Cook works from 8-6 (there are two main cooks – on a Sunday and Tuesday he finishes at 3pm and Yvonne takes over). The other cook works three days a week from 8-6 • There is a domestic staff from 9-12 seven days a week The AQAA reports that since the last inspection, the number of care hours has been increased by 28 hours a week, and the number of non-care hours has been increased to enable care staff to concentrate on their core duties. Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 23 An audit of 37 personnel files, selected to represent recruitment since the emergence of the National Minimum Standards (2002), confirmed that each has been safeguarded (though in some cases this was belatedly) with satisfactory police checks with the Criminal Record Bureau (CRB) and, in a small number of cases, POVA first checks (which are designed to enable staff to start employment and work under direct supervision until the CRB is received). Three personnel files, selected for closer scrutiny, confirmed that there was good evidence of other recruitment checks (identity, references), and induction – more recently to comply with “Skills for Care” specifications. All records seen were systematically arranged. In terms of equal opportunities and diversity, all the current residents are white British. 16 are female and 13 are male. 18 are aged over 65 years, and the rest (of various ages) have physical disabilities. The staff group comprises 13 females and 6 males (including one of the proprietors, who carries out some maintenance work around the home). Two staff are white non-British, and the rest are white British. All working ages are represented in the staff group. Each member of staff is subject to formal annual appraisals, and training thereon (including NVQ Level 2). Records confirmed a range of mandatory training, designed to keep people safe: Food hygiene, health and safety, safeguarding adults, medication, infection control, moving and handling. Staff are also given training in dementia care and mental capacity, to meet any emerging needs of the residents. The overall level of NVQ accreditation is currently reported to be 70 of the workforce. See section on “management and Administration” for findings in respect of “supervision” as defined by the National Minimum Standards. Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 24 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 good This judgement has been made using available evidence including a visit to this service. 31, 32, 33, 36, 37, 38 Residents benefit by the management and administration of the home, which is based on openness and respect. The home can demonstrate that it is implementing quality assurance systems in place, which can demonstrate how residents and their representatives can influence the way services are delivered. EVIDENCE: This home was originally a hotel, thirty years ago, and started taking people for convalescence before assuming permanent residential care status. It has been a family business since then. Both proprietors have had an active Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 25 involvement in all aspects of its organisation, and Mrs Rose (daughter of the original proprietors) has been able to demonstrate that she has the necessary qualifications in care and care management that are required to be registered by the Commission as the Registered Manager. The home has responded positively to all the matters raised at the last inspection, and (until then) had not scored less than 2 (i.e. minor shortfall) on any standard inspected by the CSCI since it assumed regulatory control in 2004. There are clear lines of accountability within the home. Team working and flexibility appear to be key strengths in this staff group. There was good evidence of residents exercising choices and control over their own daily routines. The last quality assurance initiative carried out by this home for itself was in January 2008. Although the responses had not been fully aggregated, action had already been taken to address some of the issues raised.. Feedback from that exercise and during this site visit indicates a sound level of satisfaction with the care given by staff. Comments from residents included: “I enjoy going out and enjoy the meals”; “I am happy here and think it is a well-run home”; “I like everything”; “I am happy”; “Everything’s OK thanks. No suggestions”; “Good. No complaints”; “I think your staff are very helpful and great”; “I am very pleased with everything and the staff are very good”. “Very satisfied with the care I get and the staff are all very nice, thank you”. “I am OK”. Comments from their relatives included; “Very happy with the way Ocean Swell is run and with the care and consideration **** receives”; My mother is not the easiest person to manage but the staff make her as many allowances as they can under the circumstances”; The atmosphere is always one of cheerfulness and cleanliness and there is a lot of activities for residents to join in if they wish and outings take place”; The staff are very friendly and arrange lots of activities to help clients feel part of the family”; I am very happy with the service”; “Excellent all round”; “I think that the staff are very understanding about **** and they do work well with her”; “This is a very friendly and homely environment”; I am very pleased with the way **** is being cared for”; “My aunt is looked after very well. We feel she is very well provided for and hope this continues. We were very happy with the communication when she was hospitalised recently”. The home submitted an Annual Quality Assurance Assessment (AQAA) in November 2007, and in good time for this site visit. This document was judged a comprehensive account of the issues raised, and reflected provision fairly. Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 26 The AQAA reports that the residents’ financial records have been formally audited, as evidence of its probity. The challenge will now be to make conspicuously links between the home’s quality assurance system, its business and financial planning processes to show that the views of all stakeholders do influence the way services are provided. There were risk assessments in place in respect of each individual, their activities and aspects of the environment), to ensure their health and safety are being properly safeguarded. There was also good evidence of staff supervision to comply the provisions of the National Minimum Standard to routinely cover: all aspects of practices; the philosophy of care in the homes; and career development needs Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 27 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 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 2 2 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 X 3 Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 28 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 Refer to Standard OP1 Good Practice Recommendations The home’s Statement of Purpose and Service User Guide documents should be amended to be fully compliant with all the elements of this standard. Building. The following matters are raised for attention: • Shaft lift. Door and door wall badly scuffed • Should assess whether handrails are required in G/F lobby and on 1st Floor landing • Should assess whether the covering of walls (lobby, office and one dining room wall) with training certificates detracts from homeliness of home • Consider installing Loop system for use with TVs • All kitchen chemicals should be stored in lockable facility. • Recommend kitchen cupboard used to store 1st Aid equipment is reorganised to facilitate access in an emergency DS0000023511.V359393.R01.S.doc Version 5.2 Page 29 2 OP19 Ocean Swell • • • • • • • • • • • • • • There should be a dedicated WC for kitchen staff close to kitchen with wash basin, soap dispenser, paper towels or air dryer G/F WC. Recommend look for opportunities to have door opening outwards. 1st Floor WC should have wash hand basin, soap dispenser, paper towels and lined, lidded bin. Recommend blind or curtain over window to ensure privacy. If this is for residents’ use - Recommend handle on inside of door as well as outside. Recommend look for opportunities to have door opening outwards. 1st Floor bathroom. Should have chair for assisted dressing. Recommend handles rather than knobs on door. 2nd Floor bathroom. Should have chair for assisted dressing. Should have provision to put personal effects e.g. hooks on door. One towel rail was unstable and requires securing. When rewiring bedrooms – should resite sockets 3ft from floor so that residents do not have to bend or summon help from staff Bedroom 2 – resident wants buffer on wall because stubs self. Bedroom being used to store two wheelchairs – storage for 2nd needs to be found. Needs another double socket or two single sockets. Needs table to sit at. Bedroom 3 - need to look for opportunities to replace obvious commode with more discrete model. Needs another single socket. Needs table to sit at. Bedroom 14 – Requires another double socket or two single sockets. Needs lockable space. Use of screening would disadvantage one occupant so not suitable for use as double room except for couples Bedroom 15 – requires a 2nd chair. Needs another single socket. Needs table to sit at. Needs lockable space. Ability to manage key requires documented risk assessment or consultation. Bedroom 18 – no space for 2nd chair. Needs another single socket. Needs table to sit at. Needs lockable space. Bedroom 22 Needs 2nd chair. Needs 2nd double socket. Bedroom 24 Needs 2nd double socket.. Sluice area. Floor should be coved at edges. Some dust / staining in drainer on wall. Ceiling may need refreshing Ceiling lighting needs diffusers. Soap should be in wall mounted dispenser to minimise handling by soiled hands. Mops should be stored head DS0000023511.V359393.R01.S.doc Version 5.2 Page 30 Ocean Swell up – to allow to dry. Aprons need a dispenser. 3 OP19 Periodic audits of the premises by specialists such as Occupational Therapists are strongly recommended, to ensure the home maintains its capacity to meet the needs of its residents. Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 0845 015 2255 or 0191 233 3588 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 Ocean Swell DS0000023511.V359393.R01.S.doc Version 5.2 Page 32 - 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. 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