CARE HOMES FOR OLDER PEOPLE
Osborne House 18 Compton Avenue Luton LU4 9AZ Lead Inspector
Leonorah Milton Unannounced Inspection 17th January 2006 15.50 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 Osborne House DS0000014942.V279200.R01.S.doc Version 5.1 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. Osborne House DS0000014942.V279200.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Osborne House Address 18 Compton Avenue Luton LU4 9AZ 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) 01582 493376 01582 493376 Kairmoore Limited Mrs Bridie Tarbox Care Home 16 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (16), of places Physical disability over 65 years of age (16) Osborne House DS0000014942.V279200.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20/09/05 Brief Description of the Service: Osborne House was converted from a large suburban property that was originally used as a domestic dwelling and a doctor’s surgery before conversion to its current use. It is located in a pleasant suburb of Luton near to local railway and bus services. The registered proprietor was Kairmore Ltd. Mrs Tarbox, a co-director, had managed the home for a number of years. The service was registered to provide sixteen older people who may also have dementia and/or physical disabilities. The registration for physical disabilities was not applicable to this service because the home could accommodate older persons with mobility and similar physical needs associated with old age under the category for older people. The removal of the category for physical disabilities from the conditions of registration will be discussed with the proprietor. The accommodation was arranged over two floors. It had a shaft lift for access to the upper floor. There were fourteen single rooms and one double room. The bedrooms were located on each floor, each having a washbasin and a call bell system. En-suite toilet and washbasin facilities were provided in four rooms. Communal accommodation was located on the ground floor and consisted of a comfortable lounge, a lounge/diner and an all weather conservatory. Toilet and bathing facilities were available on each floor. The ground floor bathroom had a fixed hoist to aid service users with physical disabilities. Osborne House DS0000014942.V279200.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second of the statutory two inspections that the Commission for Social Care Inspection (CSCI) is required to carry out each year. This inspection was carried out in accordance with the CSCI’s procedures to assess core care standards within the two inspections as detailed on this report. This inspection therefore focused the core standards not assessed at the first visit. During this inspection the arrangements for the care of one service user were assessed. Her case file was reviewed, as was her private bedroom. Conversations took place with this service user, her visitor, three other service users and two members of staff. A partial tour of the building took place. The manager was not present at this inspection. Feedback was given to her deputy. It was not possible to access personnel and training records in the absence of the manager. Evidence in relation to staff training was taken from other documents provided by the deputy. It is recommended that this report be read in conjunction with the report of the inspection carried out in September 2005 for a complete overview of the standard of the operation between these dates. What the service does well:
The home had been well managed to the evident benefit of service users. In common with other inspections, service users looked relaxed and comfortable within their surroundings, which were homely, well maintained and suitable for the needs of frail older people. Members of staff were observed to treat service users in a friendly, yet respectful manner. Service users with cognitive impairment were treated in a sensitive way that took account of their frailties. Service users confirmed that they were satisfied with the arrangements for their care and passed positive comments about members of staff. One service user described both the home and it’s personnel as “wonderful”. None of the service users or the relative, who had visited the home frequently, voiced any concerns about the service. The visitor was frank in her opinions and stated that she had observed both the care and ancillary team going about their business. She stated that they had always treated service users with courtesy and kindness. She was appreciative of the updates the home had provided in relation to her mother’s progress and stated that her mother’s doctor had been asked to attend when her mother had been unwell. Positive comments were also passed about the
Osborne House DS0000014942.V279200.R01.S.doc Version 5.1 Page 6 cleanliness of the home, food provision and the standard of the laundry service. There was anecdotal evidence to show that disciplinary action had been taken against a member of staff who was not working to expected standards. This employee had subsequently resigned her post and left the home. 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. Osborne House DS0000014942.V279200.R01.S.doc Version 5.1 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 Osborne House DS0000014942.V279200.R01.S.doc Version 5.1 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): 6 This standard was not applicable to this service. EVIDENCE: The deputy stated that the home did not provide a rehabilitation service. Osborne House DS0000014942.V279200.R01.S.doc Version 5.1 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): 11 The home failed to implement satisfactory procedures for service users in the event of their death. EVIDENCE: It had been a requirement that a record be maintained of any wishes that service users may have in relation to their needs at death. The deputy reported that such information was being sought from those admitted to the home after the last inspection and that the home intended to progress to those already residing in the home. There were wishes on record on the case file assessed. Osborne House DS0000014942.V279200.R01.S.doc Version 5.1 Page 10 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): These standards were not reviewed having been assessed as met at the previous inspection. EVIDENCE: Osborne House DS0000014942.V279200.R01.S.doc Version 5.1 Page 11 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): 18 There were risks that staff would not be aware of abuse of a service user(s) because there were omissions in procedural documentation and staff training. EVIDENCE: The procedural documents provided guidance for staff about action to be taken if abuse were alleged/suspected but did not contain signs to look for to indicate that abuse had occurred. Whilst the procedures contained definitions of abuse, this did not include abuse through misuse of medication. Training records maintained along side supervision records indicated that a few staff had not undertaken training in adult protection procedures. It was not possible to access personnel records at this inspection to verify that recruitment procedures had ensured the protection of service users. Osborne House DS0000014942.V279200.R01.S.doc Version 5.1 Page 12 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): The core standards in this section were not reviewed as they had been assessed as met at the previous inspection. EVIDENCE: Osborne House DS0000014942.V279200.R01.S.doc Version 5.1 Page 13 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 Written recruitment procedures were satisfactory but it was not possible to verify this against the actual employment records. The other core standards had been assessed as met at the previous inspection. EVIDENCE: Osborne House DS0000014942.V279200.R01.S.doc Version 5.1 Page 14 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): 35 Service users had been supported to retain control of some portion of their personal finances. EVIDENCE: Records and anecdotal evidence showed that at least two service users had retained control of some portion of their personal monies, as was their wish. Records seen in relation to expenditures made on behalf of service users showed that purchases were for routine expenses such as private chiropody care, hairdressing services and newspapers. The records for two service users were assessed and showed that receipts substantiated purchases and that cash balances tallied with the final balance figure. The records however had not been signed in all instances by the service user, her representative or witnessed by a second member of staff when sums of money had been given to the service user or when monies had been received on behalf of the service
Osborne House DS0000014942.V279200.R01.S.doc Version 5.1 Page 15 user. In the best interests of both service users and the home such records must be maintained. Osborne House DS0000014942.V279200.R01.S.doc Version 5.1 Page 16 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 x 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 2 x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x 2 x x x Osborne House DS0000014942.V279200.R01.S.doc Version 5.1 Page 17 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP11 Regulation 12(3) Requirement Arrangements must be made to ensure all service users wishes in the event of their death is recorded and kept on file. (Previous timescale of 30/11/05 had not been met) Procedures for the protection of service users must include guidance for staff re indicators of abuse to include the misuse of medication, as detailed by the Department of Health’s “No Secrets Guidance”. Staff must receive training in procedures for the protection of vulnerable adults/abuse awareness. Records of monies held on behalf of service users must include two signatures to show transactions to include the receipt of income and when sums have been passed to service users. Where possible service users or their representatives must sign these records. Arrangements must be made to ensure all staff be trained in health and safety to include
DS0000014942.V279200.R01.S.doc Timescale for action 31/03/06 2 OP18 12(1)(a) 13(6) 31/03/06 3 OP18 12(1)a 13(6) 18(1)(c)i 12(1)(a) 17(2) Sch 4.9 31/07/06 4 OP35 31/01/06 4 OP38 12(1)(a) 18(1)(c) (i) 31/03/06 Osborne House Version 5.1 Page 18 COSHH and Infection Control. (Previous timescales of 30.02.05, 30.04.05, 30/11/05 had not been met) 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 OP7 Good Practice Recommendations Arrangements should be made to ensure where possible service users are consulted about the care to be implemented. (Not assessed in full at this inspection) Arrangements should be made to ensure all risk assessments that identifies a medium or high level of need also implements the care intervention to ensure what care staff should do to protect the service users. (Not assessed in full at this inspection) 2 OP7 Osborne House DS0000014942.V279200.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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