CARE HOMES FOR OLDER PEOPLE
Old Hastings House High Street Hastings East Sussex TN34 3ET Lead Inspector
Jason Denny Unannounced Inspection 1st December 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 Old Hastings House DS0000021179.V269296.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. Old Hastings House DS0000021179.V269296.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Old Hastings House Address High Street Hastings East Sussex TN34 3ET 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) 01424 424027 Magdalen & Lasher Charity Natasha Jane Seymour Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Old Hastings House DS0000021179.V269296.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The maximum number of service users to be accommodated is fortyfive (45) Service users must be older people aged sixty-five (65) years or over on admission 30th June 2005 Date of last inspection Brief Description of the Service: Old Hastings House is a detached building on four floors, in which the main part of the building is listed. It is situated in the old town area of Hastings, close to the High Street and town centre, which is accessed by many of the service users. There are public transport routes nearby and also a main line railway station. The Décor and furnishings are maintained to a good standard with an ongoing decorating plan to further enhance and update the home. The home has a number of Georgian period features. Service user [Resident] accommodation comprises of 45 single bedrooms. There are a range of communal areas, which comprise of three dining rooms two on the ground floor, and one on the first floor, and a lounge and conservatory on the ground floor. There are further seating areas at the top of the stairs on the first floor and also a further lounge on this floor. There are tea corners on the first, second and third floors. Residents have the option of a weekly minibus excursion along with a range of indoor activities such as coffee mornings, luncheon clubs, quizzes, bible studies, hand massage and manicure, and wine evenings. The home has a number of strong links with the local community. A small number of bedrooms can only be accessed by those with good mobility. The home has a number of Ramps around its external grounds and entrances to facilitate disabled access. The home has two lifts, one of which is a passenger lift. Old Hastings House DS0000021179.V269296.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an Unannounced routine inspection [second of two planned before April1st 2006], which took place between 11.30am and 3.30pm. The Inspection found that 15 of the 16 National Minimum Standards inspected were fully met with 5 standards exceeded. The overall focus of the inspection was on following up on progress made since the last inspection of June 30,2005 of which this report should be read in conjunction with. Focus was also placed at looking at included residents’ involvement in the home, which included discussions and examination of a range of records. New areas looked at included how health needs are met, health and safety areas, and resident finances The inspector started the inspection by touring the home to meet with residents [13 in total]. The inspector both spoke with, and observed, staff. Other information such as contracts, complaints file and the home’s guide was examined. Comment cards were taken to the home prior to the inspection [September 2005] where a resident distributed these to residents. This new scheme was a complete success as all were completed with over 90 highly positive and others indicating some possible minor improvements. What the service does well:
A number of residents seated together made the following agreed comments about the home “ excellent, very good, no complaints, wonderful, always something going on, staff will do anything for you” The home was again found to do everything well, excelling in a number of areas. The home continues to make improvements between inspections. The management of the home was found to be especially good and dedicated to supporting residents and staff. The organisation which oversees the home was found to provide excellent support with training, financial help, and regular inspections involving residents. A range of ways were seen of how well residents are fully involved in the running of the home with regular meetings, all of which was confirmed in records and discussions with residents. The home deals exceptionally well with concerns from residents or visitors. Staff were again found to be well trained, supervised, and seen to be dedicated to their work. The home continues to offer an exceptional range of activities and maintains strong links with the community. Regular summer coach trips continue to be organised along with seasonal events. The home was again found to be good at closely monitoring all Residents to allow them to respond quickly to any changes. The overall presentation and organisation of the homes administrative records was of a good standard. The organisation continues to invest in the home to improve both the building and its facilities.
Old Hastings House DS0000021179.V269296.R01.S.doc Version 5.0 Page 6 Residents benefit from living in a well equipped, maintained, clean, and spacious home. Some Areas not inspected here were found to be exceptional at the last inspection. These areas included the number of staff with National Vocational Qualification’s in Care, the openness of the home, meals, and the overall environment. 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. Old Hastings House DS0000021179.V269296.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 Old Hastings House DS0000021179.V269296.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, & 2. The home provides existing residents, with an exceptionally good range of up to date information about the home. which keeps everyone, up to date. Information given to prospective new residents could improve to ensure that they are given a copy of the homes guide and a Contract before they agree to move in to the home. Standards 3 and 5 were fully met at the last inspection June 30, 2005. EVIDENCE: A copy of the homes resident’s [service user] guide [titled- Residents handbook] including a complaints and suggestions procedure is given to residents and visitors and is displayed in number of reception areas. The inspector found that the guide included the most recently published inspection report of January 2005. The guide also had the latest report [August 2005] of the views from residents something useful for prospective residents to base a judgement upon. The rest of the guide was found to be fully detailed. Residents were found to be knowledgeable about their rights. The home confirmed that the most recently admitted resident due to move into the home
Old Hastings House DS0000021179.V269296.R01.S.doc Version 5.0 Page 9 that day, had not been sent a copy of the home’s guide with this due to be given to her on the day. The home agreed that they would review their policy and ensure that guides are sent to all prospective new residents. The resident concerned was found not to have a copy of a sample or her actual contract, detailing the terms and conditions, the room to be occupied, including fee and who pays, sent to her before moving in. The home was found to be liaising with a relative to come in to the home following the inspection to sign the contract. The home agreed to revise their letter offering a place in the home to include a stipulation that contracts are agreed and signed before, or, at the point of entry into the home. Another resident who had just moved into the home did not have a contract on file as the family had taken the copies for signature. The home was advised to retain a copy for reference purposes. The home indicated difficulties with agreeing on entry to the home who is responsible for the fee due to delays and changes in relation to what social services eventually agree to. The home was advised to take all reasonable steps to promote transparency in the area of contracts and record where issues arise outside their control to promote the rights of residents. On a positive note the home showed how in real terms the fees charged to privately funded residents was reducing to eventually match with those who are social service funded and who get the same facilities. Those contracts, which had been signed where, found to be in order. None of the reported shortfalls was found to be affecting outcomes for residents, which remain highly positive. Old Hastings House DS0000021179.V269296.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): 8, 9, & 10. Resident’s health needs are fully met. Medication arrangements are soundly managed. Residents are treated with the highest levels of respect with all steps taken to meet their needs and preferences. Standard 7 was fully met at the last inspection. EVIDENCE: Records, observations, and discussions with residents indicated that all health needs are identified and promptly met such as dental, hearing, and visits to opticians supported by the home. Residents indicated that they all have access to the monthly visits of the chiropodist and benefit from having their own treatment room. Comment cards and discussions evidenced how pleased residents are with the sensitive support they receive from staff who were variously described as “ patient,” “wonderful and “very helpful” Staff were observed to be attentive to residents needs whilst supporting their independence. The medication stocks, records, and procedures were examined including medication cassettes. Staff and management showed through discussion a sound and full knowledge of best and safe practice.
Old Hastings House DS0000021179.V269296.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, & 14. The home provides an exceptional range of activities based on resident preferences. Residents are supported to have a full community profile and access facilities as well as maintain relationships. The home goes to exceptional lengths to involve residents in the running of the home. EVIDENCE: The inspector looked at records, comment cards from residents as well as talking and observing them, all of which indicated highly positive outcomes. Most residents spoken with indicated that there was always something going on. The range of activities continues to improve. Residents are able to make a range of choices about their lives with significant consideration given to their views and feelings, which are also discussed on admission and at the monthly Resident meetings. Activity schedules were displayed throughout the home on the high number of notice boards in entrance, reception areas, and all corners of the home. Residents spoken with confirmed how their expectations and preferences are met. On the day of the inspection the local news was relayed on a tape, there were bible studies for some, and manicure and hand massage in one of the lounges. A number of service users were either gardening or out on community walks. Activities also include quizzes, cheese and wine evenings,
Old Hastings House DS0000021179.V269296.R01.S.doc Version 5.0 Page 12 library trips and mini-bus excursions. Some residents were found to be enjoying a sherry morning. The Inspector observed some Residents gardening in the conservatory, others attending a tuck shop, some listening to music, some reading their ordered newspapers, and others out on a trip. Earlier in the morning some residents had attended an exercise class in the home. Residents confirmed the range of social contacts in the community they are encouraged to access along with maintaining existing relationships. The home supports a range of community events such as raffles and coffee mornings, which residents organise and which involve members of the public visiting the home. Residents confirmed that house meetings continue to occur monthly with minutes copied to all residents especially to those who cannot attend. The home also has a House committee, which includes 2 residents. Residents confirmed that they are involved in choosing their 2 key-workers. Old Hastings House DS0000021179.V269296.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. The home operates in an open and pro-active manner. Residents continue to have all their rights upheld. All residents and visitors are made fully aware of how to complain or raise concerns. The home continues to encourage residents to air their views. The way in which the home handles, investigates, and records complaints was again found to be exceptional. EVIDENCE: The home has a comprehensive complaint policy and form for reporting concerns. The inspector saw written examples of 2 visitors raising concerns [over the last year] and receiving a prompt and thorough response. In both cases neither concern was proven, or upheld. Any evidence, which did exist, showed good practice on the part of the home. The second complaint was raised some time after the alleged event with the complainant declining to meet with the home to discuss the concern. The commission found that in both cases that the home had acted correctly with a detailed and thorough investigation. In neither case was there any evidence that the home had been at fault nor that care given to Residents had suffered. Residents confirmed they understood the procedure and would always feel comfortable talking to the manager and staff. The complaints procedure was found to be on display throughout the home and is also given to Residents and their relatives on admittance. A complaint made by a resident about the behaviour of another was found to have been fully recorded 3 days before the inspection. An investigation had already begun with the complainant happy with the action taken, with the alleged culprit deciding that they wanted to move out of the home.
Old Hastings House DS0000021179.V269296.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26. Residents live in a clean, pleasant and hygienic environment. EVIDENCE: The Inspector toured communal parts of the home such as lounges, bathrooms and dining areas along with hallways finding them all to be clean. During the inspection the home made improvements to the odour of a designated smoking room by removing a cigarette bin when some residents chose to use this room as a third dining room area. Old Hastings House DS0000021179.V269296.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30. Staff are well trained and have the best possible induction into the job. Previous minor shortfalls in this respect have been fully addressed since the last inspection. Standard 27-29 fully met at the last inspection with standard 28 exceeded. EVIDENCE: The Inspector sampled examples of induction workbooks for two new staff. These were found to have been completed within a normal timescale covering a range of areas such as emergency procedures, policies and procedures, care plans, values and sections where new staff can show what they have learnt. New induction books have also been introduced called TOPSS induction, safe working practices [now renamed Skills for Care], which is completed within 6 weeks of the new person commencing employment, followed by foundation training within 6 months unless the staff person goes straight on to National Vocational Qualification. All staff have gone through the 6 week induction since the last inspection. One of the staff persons referred to indicated in discussions the thoroughness of her induction which also involved working a week of shadowing senior staff. She stated how well supported she found this induction. She is currently half way through her National Vocational Qualification level 2. The inspector found that the new training provider who coordinates staff training has organised 6 month foundational training starting in January 2006 for all those staff who have not achieved or started National Vocational Qualification level 2 in Care.
Old Hastings House DS0000021179.V269296.R01.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, & 38. Old Hastings House is openly and exceptionally well managed in the best interests of residents who are fully involved in the running of the home. The management of the home ensure that they are well informed about resident’s and staff’s viewpoints. Staff receive regular support through meetings, helpful inductions, and supervision to assist them to do a good job. A safe environment is maintained for residents with them protected from harm by well-trained staff. EVIDENCE: The registered manager has managed the home for a number of years and is well qualified, achieving the industry-recognised qualification: namely, the registered managers award and NVQ 4, 2 years ago. The home was found to run well in the mangers absence by a competent, qualified and motivated senior staff person. The managing organisation produces detailed monthly reports, which include resident’s and staff’s views. The manager continues to
Old Hastings House DS0000021179.V269296.R01.S.doc Version 5.0 Page 17 work towards developing effective quality monitoring systems that are user friendly such as the recent introduction of house committee’s which involve a range of people including Residents. The inspector spoke to the one of the Resident chairperson’s on the committee, who confirmed how the home continues to respond positively to suggestions. All residents spoken with confirmed that they have open access to supportive management and staff. Comment cards were taken to the home prior to the inspection [September 2005] where a resident distributed these to her peers. This new scheme was a complete success as all were completed with over 90 highly positive and others indicated some possible minor improvements. The inspector looked at the homes own most recent survey of resident views carried out in August 2005 which evidenced 100 satisfaction levels with some indicating excellence in areas such as food, activities am and overall care. 75 of residents participated in the home own survey. The report was found to be published in the home’s guide. Residents finances are well managed by the home as seen in records and storage arrangements examined, which showed accurate running totals of those small amounts of money which the home manages on behalf of some residents. The inspector found that all staff were receiving supervisions at least every two months. The inspector sampled two files. One indicated that written supervisions took place on 030905 and 291005. The newest staff person had received a written supervision after her first month. The quality and detail in these supervisions was found to be good and helpful to the staff concerned. Records showed that all aspects of health and safety were being met this included looking at appliance safety certificates, staff training, and accident records. All staff recently received in September 2005 updated Moving and Handling training with all staff having either received or booked on to other health and safety type training. All accidents are promptly reported to the Commission, with the home responding effectively to such instances. Old Hastings House DS0000021179.V269296.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 X COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 x X X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 3 X 3 Old Hastings House DS0000021179.V269296.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5[1b&c] Requirement That each Service user [Resident] is provided with a Statement of Terms and Conditions [Contract] at the point of moving into the home, or sooner. That this includes all the items indicated in the standard such as fees payable and by whom, and the room to be occupied. That the contract is signed on admittance by the service user, and, or, their representative at the point of moving into the home. Requirement first made 30/06/05. Requirement of the last 2 Inspections. Timescale for action 01/01/06 Old Hastings House DS0000021179.V269296.R01.S.doc Version 5.0 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Old Hastings House DS0000021179.V269296.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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