CARE HOMES FOR OLDER PEOPLE
Osborne House 18 Compton Avenue Luton LU4 9AZ Lead Inspector
Andrea James Unannounced Inspection 20th September 2005 12:00 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 Osborne House DS0000014942.V249144.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. Osborne House DS0000014942.V249144.R01.S.doc Version 5.0 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.V249144.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 03/03/05 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. At this inspection the standard of the décor and furnishing were high throughout. The accommodation was arranged over two floors. It had a shaft lift for access to the upper floor. The house provided for older people and also those who have physical disabilities and dementia in 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.V249144.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 inspection carried out on the 20th of September 2005 and lasted for 3.5 hours. The Registered manager was not present for the inspection but one of the senior partners in the company was available for the inspection who was also a carer. The inspection was carried out 6 months after the last inspection. The inspection followed a case tracking methodology where a sample of the service users were chosen at random and their records were examined in detail. The service users chosen were also spoken to along with other service users available in the communal areas of the home. The inspection also reflects the views of visiting professionals, care staff, relatives, team leaders and the management team. What the service does well:
The home provides satisfactory standards of care to the 16 service users. The care staff, external professional and visitors spoken to were positive about the care provided by the home. They all suggested that the service users received high standards of care. Service users and relatives said the home was “excellent”, the carers were “Tops”, and they displayed sound knowledge of the service users needs. Service users said they found the staff friendly and cuddly and wouldn’t change them. A service user said the night staff were particularly nice and good to her. The staff were observed to be friendly and caring to the service users and relatives and external professionals were treated with respect and courtesy. The home encouraged the service users to participate in various activities and a list of activities was displayed in the communal areas of the home. The home had an allocated staff that ensured activities were planned in advance to meet the needs of the service users. The home had satisfactory assessment tools that identified the needs of the service users and as a result the needs of the service users were satisfactorily recorded in individual care plans. Service users were offered a choice of meals and the meals provided appeared to be of a nutritious balance. The catering staff was seen interacting with the service users in a positive way. Osborne House DS0000014942.V249144.R01.S.doc Version 5.0 Page 6 The home had a core of staff that appeared to enjoy the job. They were experienced and appeared dedicated to meeting the needs of the service users. The home had ensured that a large amount of staff were adequately trained and some of the care staff had achieved their NQV level 2 qualification in care. 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.V249144.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 Osborne House DS0000014942.V249144.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): 1,2,3,4 and 5. Satisfactory processes were in place to ensure service users were informed about the home, had satisfactory assessment and contractual agreements and were able to visit the home prior to admission, as a result service users were confident in the services provided by the home. EVIDENCE: The service users and relatives spoken to said they received a Service Users Guide. The Statement of Purpose was inspected and satisfactorily met the standards. Two new admissions to the home said their relatives were able to view the home before they moved in. The team leader explained that all new admissions are placed in the home pending a 6 weekly review. Contracts were seen on service users files. The assessment tools were seen for service users prior to and after admission to the home, all were completed and identified the level of need required. Osborne House DS0000014942.V249144.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): 7,8,9,10 and 11. The home had good processes in place to meet the health care needs of the service users, as a result service users personal and health care needs were satisfactorily met. The home failed to implement satisfactory procedures for service users in the event of their death. EVIDENCE: The home had pre admission assessment and admission assessment tools that were satisfactorily completed to identify the needs of the service users, as a result full and comprehensive care plans were generated. The care plan documentations were reviewed on a monthly basis and where necessary risk assessments were completed. The risk assessments needed further development to ensure care intervention is recorded where the risk is either of a medium or a high level. On the day of the inspection several external medical professionals visited the home and commented that the home was proactive in identifying the needs of
Osborne House DS0000014942.V249144.R01.S.doc Version 5.0 Page 10 the service users. A district nurse said the staff displayed sound knowledge of service users treatment regimes and were able to follow requests. Another professional said staff were competent in meeting the health care needs of the service users. Service users spoken to said the staff treated then with dignity and respect, special mention was made of the night staff who were always “lovely” to them. The care plans failed to show what the wishes of the services users were in the event of their death. The home had satisfactory medication procedures. The inspection round was observed and the carer appeared competent in administering medication. There was however a need for further training to ensure all staff are aware of the medications being administered within the home. The home had no controlled drugs at the time of the inspection but had satisfactory processes in place to be able to administer controlled drugs. Osborne House DS0000014942.V249144.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 and 15. The home was good at encouraging service users to live a fulfilled lifestyle that met with their requirements and their needs, as a result they were able to have regular family contact, good and nutritious meals and were able to exercise control over their lives where possible. EVIDENCE: The home had an activities co-ordinator that arranged for a wide variety of activities to be undertaken in the home. The home also had a display board where activities were advertised in an attractive and pictorial way. Service users spoken to said they enjoyed the activities provided. Relatives said they were satisfied with the level of activities provided for the service users. Records of past and future activities were kept in the home. Service users said they were able to maintain regular contact with their families. The relatives spoken to on the day of the inspection said they were always made to feel welcome and felt the home was able to meet the needs of their relatives. The home provided nutritious and wholesome meals for service users and the menus inspected suggested choices were offered. On the day of the inspection
Osborne House DS0000014942.V249144.R01.S.doc Version 5.0 Page 12 a service user was observed to be offered a different meal because she did not want the main meal. Service users spoken to said they enjoyed the meals they were offered. Relatives said “the food is good here”, the service users always seemed to enjoy it and sometimes asked for more. Osborne House DS0000014942.V249144.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 had satisfactory complaints procedures in place that would ensure service users complaints would be dealt with if they were to complain. EVIDENCE: The home had satisfactory policies and procedures in place that would enable them to deal with complaints received. The home received one complaint since the last inspection and had satisfactorily completed their investigations, as a result of the complaint the home implemented better guidelines for dealing with difficult service users and improved on the accountability of the home by ensuring a lead carer was identified on each shift. The home ensured that the commission was aware of the outcome of the investigation. Osborne House DS0000014942.V249144.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): 19,20,23,24,25,26 The home maintained good environmental standards, both in communal areas and in service users bedrooms, this ensured that service users were provided with safe and comfortable surroundings that was clean and hygienic and met with their needs. EVIDENCE: The home was welcoming and was decorated to a moderate standard. The service users bedrooms were satisfactorily decorated to meet the needs of the service users. The bedrooms seen had individual belongings for service users. The service users spoken to said they liked their bedrooms. The care staff said improvements have been made to ensure the safety of the service users in various areas of the home. On the day of the inspection the car park was being refurbished to ensure it was more accessible for the service users. There was evidence to suggest the home had risk assessed the safety of the service users should they wish to use the outdoor facilities while the car park was being refurbished.
Osborne House DS0000014942.V249144.R01.S.doc Version 5.0 Page 15 The home had one ancillary staff that cleaned the home on a part time basis as the care staff carried out the major part of the cleaning regime. The cleaner said she only did the jobs that the care staff could not do. The care staff said they did not mind doing these duties and did not feel they detracted them from caring for the service users. The home was clean and free from offensive odours. Osborne House DS0000014942.V249144.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,30. The home provided sufficient numbers of staff that were trained, competent and experienced in meeting the changing needs of the service users. EVIDENCE: The home had satisfactory numbers of care staff to meet the needs of the service users. The home had limited numbers of ancillary staff, as a result care staff were expected to carry out domestic duties which included laundering of service users clothing, preparing service users suppers and other domestic duties. The care staff spoken to felt this procedure was satisfactory for the home and did not feel the service users received less care because of their additional duties. The staff spoken to said the home ensured they were adequately trained. The home had a training matrix that provided substantial evidence of staff training. There was also a record of training scheduled for future months. The home had ensured that 5 of the 12 care staff had achieved their NVQ level 2 in care and another 2 carers were due to complete in the near future. The care staff spoken to were able to demonstrate their knowledge and competency in meeting the needs of the service users. Service users spoken to said the care staff were good at their jobs and wouldn’t change anything about them. Relatives said the care staff are “excellent” and provide good standards of care.
Osborne House DS0000014942.V249144.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): 31,32,33,36 and 38 The manager of the home created a good leadership ethos that both service users and care staff were able to benefit from. EVIDENCE: Service users spoken to felt that the manager was approachable and she wanted the best for them. It was apparent that the service users and manager were able to effectively communicate. The home operated an open door policy and the service users appeared comfortable in approaching the management team. Osborne House DS0000014942.V249144.R01.S.doc Version 5.0 Page 18 The records showed that all care staff were supervised. Those spoken to said they received regular supervisions and commented that they also had regular staff meetings. The home had satisfactory health and safety procedures in place. The records inspected were satisfactorily maintained. Osborne House DS0000014942.V249144.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 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 1 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 x 18 x 3 3 x x 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x x 3 x 3 Osborne House DS0000014942.V249144.R01.S.doc Version 5.0 Page 20 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 OP11 Regulation 12 (3) Requirement Timescale for action 30/11/05 2 OP19 13 (2) (c) 1 OP38 (4) 1 Arrangements must be made to ensure all service users wishes in the event of their death is recorded and kept on file. A risk assessment must be 30/11/05 carried out on the safety of the service users while the car park is being refurbished. Arrangements must be made to 30/11/05 ensure all staff are trained in health and safety to include COSHH and Infection Control. Previous timescale: 30.02.05/30.04.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP7 Good Practice Recommendations Arrangements should be made to ensure where possible service users are consulted about the care to be implemented. Arrangements should be made to ensure all risk
DS0000014942.V249144.R01.S.doc Version 5.0 Page 21 Osborne House 3 OP27 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. Arrangements should be made to ensure the care staff are trained in abuse awareness and medication awareness. Osborne House DS0000014942.V249144.R01.S.doc Version 5.0 Page 22 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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