CARE HOMES FOR OLDER PEOPLE
Oldfield Bank 5 Highgate Road Altrincham Cheshire WA14 4QZ Lead Inspector
Val Bell Unannounced Inspection 21st December 2005 10:00 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 Oldfield Bank DS0000005625.V270498.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. Oldfield Bank DS0000005625.V270498.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Oldfield Bank Address 5 Highgate Road Altrincham Cheshire WA14 4QZ 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) 0161 928 0658 Mrs Anne Leavy Mr Lawrence Leavy Mrs Anne Leavy Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability over 65 years of age (0) of places Oldfield Bank DS0000005625.V270498.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. All service users will fall within the category of old age and may additionally have a physical disability. 2nd August 2005 Date of last inspection Brief Description of the Service: Oldfield Bank provides accommodation and personal care for up to twentyeight residents within the category of old age. Residents may also have a physical disability. Mr Lawrence and Mrs Anne Leavy own Oldfield Bank with Mrs Leavy being the registered manager. Mrs Leavy is supported by Karen Sykes the deputy manager. The home is a large detached property, which has been extended and is set in pleasant grounds. The enclosed gardens are well maintained and residents can sit or stroll in the grounds. Car parking spaces are provided at the front of the building. The home has 26 single bedrooms, six of which are en-suite. Upper floors are accessed by a passenger lift and stairways. The home is situated within a residential area of Altrincham and is a short distance from shops, transport links and the motorway network. Oldfield Bank DS0000005625.V270498.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted during daytime hours on 21st December 2005. The focus of the inspection was to assess progress on the outstanding requirements and recommendations made at the previous inspection. Additionally, the Commission’s pharmacy inspector had visited the home on 6th December to undertake an assessment of the homes system of medication administration. During the inspection records, including care plans, were assessed, a tour of the building was undertaken and conversations were held with care staff and five residents. The fifteen requirements and two recommendations made at the previous inspection had been met. Three requirements and two recommendations were made during this inspection. What the service does well: What has improved since the last inspection?
Oldfield Bank DS0000005625.V270498.R01.S.doc Version 5.0 Page 6 Significant improvements had been made to the homes assessment of need and care planning systems and care staff had become more involved in developing care plans. Similarly, improvements had been made to the system for the administration of medication. An appropriate format for the recording of complaints and their outcomes had been introduced since the previous inspection and residents told the inspector that staff always listened to their concerns and acted upon them. The home received a commendation in the area of staff induction and training. Considerable action had been taken to introduce a programme of staff development and records provided evidence of best practice in this area. Various environmental improvements relating to fire procedures and the use of bed rails had ensured that the welfare and safety of residents was protected. This had also resulted in improvements to the right of residents to freedom of movement around the home. Finally, two good practice recommendations had been taken on board by the home. Evidence was provided to demonstrate that residents had access to a structured activity programme and care staff had become more involved in developing residents’ care plans. 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. Oldfield Bank DS0000005625.V270498.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 Oldfield Bank DS0000005625.V270498.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): EVIDENCE: None of the Standards in this section were assessed on this occasion. Oldfield Bank DS0000005625.V270498.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 Significant improvements to the assessment of need, care planning and medication systems ensured that residents’ needs would be identified and generally met. Minor shortfalls in care planning and the administration of medication meant that the home could not demonstrate that individual’s needs were being met in all instances. EVIDENCE: Five care plans were assessed during this inspection. Significant progress had been made in developing care plans since the previous inspection. The home had adopted an in-house assessment of need that followed the structure of the needs assessment used by the local authority. This ensured consistency in identifying the holistic needs of people admitted to the home. Care plans included a comprehensive social needs assessment, residents’ like and dislikes, weight monitoring, risk assessments (including moving and handling) and risk management plans and residents had signed their care plans to indicate their agreement with the contents.
Oldfield Bank DS0000005625.V270498.R01.S.doc Version 5.0 Page 10 The care plans had been subject to monthly review. Further development was needed to detail how care staff would meet individual resident’s needs. One of the needs assessments stated that the resident was to be bathed using a hoist, however this had not been included in the care plan. A requirement was made accordingly. Furthermore, a good practice recommendation was made for all hoists to be washed down with hot soap and water in between use, to prevent cross-infection. The pharmacy inspector had made several requirements during her visit to the home on the 6th December 2005 and it was encouraging to note that significant progress had been made to address the issues identified. In consultation with the local pharmacy the home had agreed an action plan. This included medication training scheduled for April 2006, checking and signing for incoming medication, risk assessments for self-medication, secure storage of medication records, photographs of residents and accurate medication records. The home had also ordered a controlled drugs cabinet. However, a second member of staff was not countersigning handwritten additions to the medication administration records and the home was not having sight of individual resident’s prescriptions. These two shortfalls have been re-iterated as requirements in this report. Oldfield Bank DS0000005625.V270498.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 and 13 A lively Christmas entertainment programme and the involvement of residents’ families and friends provided stimulation and interest in resident’s daily lives. EVIDENCE: Standards 12 and 13 were not fully assessed on this occasion, however residents told the inspector that Christmas celebrations had been provided. A Christmas party had been held the week prior to this inspection and residents said that their relatives had friends had been invited to attend. A carol service had also been held. The residents were looking forward to a sherry afternoon on Christmas Eve. Some of the residents said that they were going to spend Christmas with their relatives and others were looking forward to their families visiting them at the home. Oldfield Bank DS0000005625.V270498.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Residents could be confident that any concerns they might have would be addressed satisfactorily and the homes procedures for protecting vulnerable adults ensured that the people living in the home would be safe from abuse. EVIDENCE: Since the last inspection the home had implemented a complaints recording system. The investigation and outcome of complaints was being appropriately recorded. Residents told the inspector that their concerns were always listened to and acted upon. The deputy managers had attended training in the protection of vulnerable adults from abuse and further training had been arranged for the care staff. Oldfield Bank DS0000005625.V270498.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Improvements made since the last inspection ensured that the safety and welfare of residents, including their right to freedom of movement, was protected. EVIDENCE: A monitoring visit was undertaken since the previous inspection to assess progress made in relation to the use of bed rails and residents right to freedom of movement within the home. It was encouraging to note that rapid action had been taken to comply with the requirements made. All bed rails had been fitted with bumper pads and items of furniture had been removed from the vicinity of resident’s beds. As required at the previous inspection, advice had been sought from the fire officer on the use of door wedges. This practice had now ceased. This had caused some anxiety to two of the residents who had requested that their bedroom doors remain open.
Oldfield Bank DS0000005625.V270498.R01.S.doc Version 5.0 Page 14 The registered person had taken advice on how to address this problem and a suitable alternative was being researched. The outcome will be assessed at the next inspection. Oldfield Bank DS0000005625.V270498.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): 29 and 30 Robust recruitment procedures and effective staff training and supervision ensured that a competent and confident staff team was meeting residents’ needs. EVIDENCE: Robust procedures for the recruitment of staff had been implemented and included the required pre-employment checks. Since the previous inspection the cook had resigned. The registered manager and one of the deputy’s were temporarily covering the position. The home had introduced a comprehensive induction programme that complied with ‘Skills for Care’ guidance. This included a full training needs assessment for individual staff. Senior staff had worked hard on developing and implementing an ongoing training programme for the staff team. Since the last inspection various training courses had been provided including awareness of abuse, diabetes, moving and handling, medication administration, NVQ 2, first aid appointed persons, food hygiene and blood glucose monitoring. Oldfield Bank DS0000005625.V270498.R01.S.doc Version 5.0 Page 16 Training records were in place and included a training matrix. The home received a commendation for best practice in this area for the significant progress that had been made since the previous inspection. Staff had been issued with copies of the General Social Care Council Codes of Conduct and carers confirmed that they were receiving formal supervision every two months. Oldfield Bank DS0000005625.V270498.R01.S.doc Version 5.0 Page 17 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): 32 and 38 Effective leadership and good health and safety practices ensured that the welfare of residents’ was protected. EVIDENCE: Effective management and leadership were in evidence in the home. One of the deputy managers had achieved NVQ level 4 in care and was currently undertaking the registered managers award. The second deputy was currently studying NVQ level 4 in care. Care staff were more actively involved in the care planning process and had taken responsibility for writing the daily reports. It was also noted that residents were being encouraged to maximise their independence and supported in taking normal everyday risks. Oldfield Bank DS0000005625.V270498.R01.S.doc Version 5.0 Page 18 The homes accident book was examined and found to be accurate and up to date A fire risk assessment had been done and the local fire officer had validated this. The required fire checks had been conducted at appropriate intervals and records were accurate and up to date. Oldfield Bank DS0000005625.V270498.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X X X X 3 Oldfield Bank DS0000005625.V270498.R01.S.doc Version 5.0 Page 20 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. 1. 2. Standard OP7 OP7 Regulation 15 15 Requirement Care plans must include detail to show how residents’ specific needs will be met. Information relating to the moving and handling needs of residents must be included in their care plans. The registered person must ensure that up to date information on prescribed medication is held for each resident and that the prescriptions are seen by the home. Timescale for action 21/03/06 21/03/06 3. OP9 13 (2) 21/03/06 Oldfield Bank DS0000005625.V270498.R01.S.doc Version 5.0 Page 21 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. 2. Refer to Standard OP7 OP9 Good Practice Recommendations It is recommended that hoists and other moving and handling equipment be washed down with hot soap and water in between use. It is recommended that all hand written entries are signed by the person making the entry and then countersigned by a second member of staff to check the accuracy of the entry. Oldfield Bank DS0000005625.V270498.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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