CARE HOMES FOR OLDER PEOPLE
Overton House 2 Newton Avenue Longsight Manchester M12 4EW Lead Inspector
John Oliver Unannounced 8th June 2005 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 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. Overton House F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Overton House Address 2 Newton Avenue Longsight Manchester M12 4EW 0161 273 2555 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Michael Newton Asomaning Mrs Angela Asomaning Mrs Angela Asomaning Care home only (PC) 19 Category(ies) of Old age, not falling within any other category registration, with number (OP) (18) of places Mental disorder, excluding learning disabilty or dementia - over 65 years of age (MD(E)) (1) Overton House F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1 The home may accommodate a maximum of 18 service users who require personal care only by reason of old age (OP). 2 One named service user requires personal care only by reason of mental disorder MD(E). Should this service user no longer require the accommodation offered by the home then the place will revert to old age (OP). Date of last inspection 01 March 2005 Brief Description of the Service: Overton House is a privately owned residential care home providing personal care and accommodation for 19 older people. The home is located in the Longsight district of Manchester. Longsight is a multicultural residential area, which is close to the city centre and is within reach of good transport links to Stockport and surrounding areas. The home is a large Victoria style property. It is located on a corner plot by a busy junction of the A6. Bedroom accommodation is on the ground and first floors. There are 3 single and 8 shared bedrooms. All rooms have a wash hand basin and basic furnishings are provided. None of the rooms have en-suite facilities. There is a passenger lift. Accessible toilets and bathrooms are located on both floors near to bedrooms and living rooms. There are two lounge facilities on the ground floor, one of which is the designated smoking area. A separate dining room is available. Overton House F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 8th June 2005 over a six hour period. The inspection involved spending time talking with the manager and staff of the home who were on duty at that time. Time was also spent talking with a number of residents who wanted to say how they found living in the home. Some time was spent looking at files, records and the home’s policies and procedures. The inspector also had a look around the inside of the home as well as having a walk around the outside of the building. At the last inspection, which was done in March 2005, a number of improvements were identified that needed to take place. Most of these had been completed when they were checked at this inspection. However, where these improvements had still not been done they have been included again in this report. Not all standards were checked at this inspection and it is strongly advised that this report should be read together with the last inspection report and any future inspection reports to get a full picture of how the service is meeting the needs of the residents living there. What the service does well:
The manager and staff team of the home have worked hard to provide residents with a comfortable and safe place to live. Watching staff at work gave a good indication of their commitment to providing residents with a pleasant atmosphere in which to live. A lot of time has been spent in making sure that individual residents get support in the way that is most important to them. One particular area of support the home does well is making sure other healthcare people such as G.P’s, district nurses and community psychiatric nurses are involved in maintaining the health of the individual. The manager sees training as very important in making sure staff are able to carry out their job in the best way possible. Staff employed in the home have developed the skills through training to enable them to supply support to the residents to a high standard.
Overton House F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Version 1.30 Page 6 Talking with a number of residents the inspector was told that “meals are very good”, “sometimes too much”. “Staff are very good”, “staff are always ready to help”, and “the manager talks to everyone, every day”. Talking with a number of staff the inspector was told, “managers are very good”, “managers are brilliant”, “we are well supported with training” and, “residents are well looked after”. The home is also working towards achieving the Investors in People Award and hope to be assessed by September 2005. This will also help staff in delivering a good service. What has improved since the last inspection? What they could do better:
Although care plans overall are very good and give staff enough information so that they can support residents in meeting their needs, these plans were not being checked on a monthly basis to see if any changes had taken place to the care an individual resident may need. Doing this would help to make sure that
Overton House F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Version 1.30 Page 7 residents could remain as independent as possible with the right support being available when required. The manager and staff of the home place a lot of importance on maintaining a good standard of care for the residents in the home and also in maintaining a clean and hygienic place in which to live. However, at the time of the inspection staff were not using the hand washing facilities in the laundry after dealing with soiled linen. This could mean that any infection present could be transferred throughout the home. 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. Overton House F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Overton House F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,5 and 6 In most cases, prospective residents were being assessed prior to admission into the home. Overall, trial visits to the home were made available to enable an assessment of the suitability of the services being offered to a potential resident. In addition, prospective residents were given significant information about the service offered prior to admission. EVIDENCE: The service had updated the Statement of Purpose and Service User’s Guide to meet a requirement issued during the last inspection. These documents would be made available to anyone interested in coming to live at Overton House. The files of two residents recently admitted to the home were examined. Both contained Care Management Assessments and the pre admission assessment carried out by the manager of Overton House. Overton House F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Version 1.30 Page 10 Information contained within one file gave a clear indication that the resident had used “trial visits” to the home to help her make a choice about where she wanted to live. Observing interaction between residents and staff and discussion with residents and staff indicated that the home was able to meet the needs of the residents currently accommodated. Healthcare professionals from other agencies were seen to visit individuals in the home during the inspection. Case notes also indicated regular and consistent interaction from healthcare professionals. This information helped to confirm that the needs of residents were being met at the time of this inspection. Overton House does not offer the service of intermediate care and the manager confirmed this. Overton House F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Version 1.30 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 and 10 Information with regards to residents identified care needs was available to show how the health and social care needs were being met. Although reviews of care plans and risk assessments would be beneficial to safeguard resident’s welfare. Residents were treated with respect and privacy was maintained and upheld. EVIDENCE: Care plans and risk assessments had been completed for each resident living in the home. These were comprehensive in content and gave clear guidelines to staff in how to support the person to meet their identified needs and goals. However, care plans did not identify the choice of the resident regarding bathing. This must be addressed to ensure residents preferred choice is met. A number of care plans had been signed by the resident or their representative but not all. Reviews of care plans and risk assessments had not taken place on a monthly basis.
Overton House F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Version 1.30 Page 12 Two files were examined that confirmed the district nursing service was involved in the monitoring of tissue viability for these particular residents. Appropriate aids and adaptations had also been provided to provide comfort to these residents and to prevent further pressure area development. Discussion with staff during the inspection indicated they had good background knowledge of the individual’s needs. Daily records maintained in the home and discussion with 3 residents confirmed that identified needs were being met. A number of residents spoken to also confirmed that they were able to see their doctor or other healthcare professionals in the privacy of their own rooms. Overton House F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Version 1.30 Page 13 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 standard(s) 12 Residents have choice and support to meet their expectations and preferences regarding their daily lifestyle. EVIDENCE: The routine of the home was relaxed and informal. Residents had opportunity to spend time socialising in communal areas or in the privacy of their own rooms. Staff interaction with residents was positive and time was spent encouraging individual residents to participate in activities of their choice. Two residents stated that they were able to go out of the home to shop and attend church whenever they wished to. Their individual care plans confirmed that this was part of their identified package of care. Appropriate risk assessments had also been completed. Regular entertainment was booked and discussion with a number of residents confirmed that they were involved in choosing this. Overton House F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Version 1.30 Page 14 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 standard(s) 16 and 18 The home has relevant policies, procedures and systems in place to enable concerns to be raised and to protect residents from neglect and/or abuse. EVIDENCE: A record of complaints was kept. No complaints had been recorded since the inspection conducted in March and the manager confirmed that no other complaints had been received. The Commission for Social Care Inspection had received no complaints. Discussion with two residents demonstrated that they were clear about how and who to make a complaint to. The home had a comprehensive abuse policy including the Department of Health guidance, “No Secrets”. No allegations or incidents of abuse had been made since the last inspection. Discussion with the manager indicated that she had a clear understanding of procedures to follow in the event of any allegations of abuse being made. However, the managers’ husband, Mr Michael Asomaning who is also the registered provider has not applied for a Criminal Record Bureau check. This was a requirement from the last inspection and has been reiterated in this report. The home had a policy regarding dealing with resident’s money and financial affairs. This gave clear directions to those staff with responsibility for dealing with these matters.
Overton House F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Version 1.30 Page 15 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 standard(s) 19,20,21,22,23,24 and 26. Overall the general environment of the home was clean, tidy and comfortable with systems in place to protect the safety of residents. EVIDENCE: Evidence available indicated that some routine renewal and maintenance of the home had taken place since the last inspection. A number of requirements identified during the inspection conducted in March 2005 have been addressed and those found to be still outstanding have been reiterated in this report. Bedrooms viewed during the inspection confirmed that a programme of redecoration was taking place and that some furniture had been replaced with new. Those bedrooms seen were clean, comfortable and personalised to varying degrees reflecting the character of the resident. At the time of the inspection, the manager was in the process of conducting an audit of all bedrooms to make sure that the contents of the rooms met the individual requirements of the resident. This action means that a requirement issued at the last inspection had now been met.
Overton House F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Version 1.30 Page 16 One shared bedroom is an unusual shape and this makes it difficult to furnish it appropriately. A recommendation has been made to consider making this particular room into a single room. Three new leather armchairs had been purchased for the main lounge and the manager stated that replacement of lounge chairs would be an on going process. This new furniture added to the comfort for the residents. The flooring in the communal areas is the original paraquet (wooden) type and is in need of securing in places to prevent trips and falls. The bathroom and toilets were sufficient in numbers to meet resident needs. However, the vinyl flooring in the bathroom and toilets near to room 5 is in need of replacement. This flooring looked extremely dirty although the manager confirmed it was regularly cleaned and no unpleasant odours were detected. Closer inspection of this flooring confirmed that it was the colour and patterning that gives the impression of the vinyl being dirty. The manager agreed that it would be replaced to ensure that the cleanliness of the floor could be easily seen and the health of the residents maintained. Laundry facilities were sited in the basement of the home and include two washing machines and two dryers. Hand washing facilities were available for staff but the poor condition of the sink and lack of appropriate soaps and paper towels were a clear indication this process was not happening after staff had handled soiled linen. The manager must ensure that appropriate facilities are available at all times to control and minimise the risk of cross infection. Externally, the property was reasonably well maintained. The rear garden is not accessible to residents because of the difficult layout and unevenness and the Service User Guide confirms this. However, the pathways leading through and around the front garden and up to the front door are uneven and requires repair to prevent slips, trips and falls. This was a requirement issued during the last inspection and, although the timescale of 30th June 2005 had not expired at the time of this inspection the manager asked that an extension to the timescale be given. Until the work has been satisfactorily completed a risk assessment must be put in place. Overton House F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28 and 29 The recruitment and training policies and procedures now in place provide sufficient competent and well trained staff whose performance is regularly monitored. EVIDENCE: The staff team in the home consisted of the Manager, 2 assistant managers, 12 support workers and 3 ancillary staff. Working rotas were available for inspection and confirmed that staffing levels in the home were sufficient to meet the needs of the residents in the home. Since the last inspection, conducted in March 2005, a significant improvement had been made in ensuring that all the staff team held appropriate Criminal Record Bureau disclosure certificates on file. These were examined during this inspection and evidence available confirmed that Protection of Vulnerable Adults (POVA) first checks had been carried out and were on going. This practice was now ensuring that all staff working in the home had received appropriate pre-employment checks before actually commencing their employment. However some inconsistencies in file contents were still apparent and this must be addressed. Six care staff had completed National Vocational Training (NVQ) level 2 and, at the time of the inspection, two care staff were in the process of working toward gaining NVQ level 3. Discussion with the manager confirmed that it was expected that 50 of the staff team would have achieved NVQ level 2 by September 2005. Discussion with a number of staff indicated that this
Overton House F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Version 1.30 Page 18 training was seen as positive in helping to further develop knowledge and skills relating to the job they do. Overton House F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,34,37 and 38 Residents’ living in the home benefit from having the support of a manager with skills to provide and develop a good quality service and has procedures in place to promote and protect their interests. EVIDENCE: The manager has completed various training courses and holds both the Certificate and Diploma in Management Studies. This level of training has aided the manager to support the staff team in further developing an open and transparent service. A copy of the business plan for the home was provided. A chartered accountant maintained the business account to ensure financial viability. Appropriate insurance cover was in place and the certificate was displayed. Overall, records seen during the inspection were found to be up to date and securely held. However, as previously indicated, a number of staff files were
Overton House F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Version 1.30 Page 20 inconsistent in their contents. The home had a health and safety file that had been compiled by a professional organisation. Policies and procedures in this file related specifically to the requirements and compliance with relevant legislation. The manager confirmed that regular ‘updates’ were received. Relevant certificates were on file to show that appropriate servicing of equipment used in the home had been carried out. Accident records were being appropriately maintained and a requirement from the last inspection to ensure more details were included in these reports had been met. The manager had also produced and completed a monthly ‘accident analysis’ sheet to monitor this. No evidence was available to indicate that hot water temperatures were being monitored on a regular basis. There is a potential risk to residents of scalding from water temperatures being too hot. Overton House F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 2 3 3 3 3 3 x 2 STAFFING Standard No Score 27 3 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x x 3 x x 2 2 Overton House F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Version 1.30 Page 22 yes 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 11 Regulation 15 Requirement Care plans and risk assessments must include residents preferred choice regarding bathing. Both documents must be reviewed on a monthly basis. Mr Michael Asomaning must apply for a Criminal Record Bureau check (Timescale 30.04.05 not met). Pathways around the premises must be checked and re-laid/resurfaced where the concrete has cracked and become uneven. (Timescale 30.06.05 has been extended) The control to the radiator in the dining room must be replaced when the heating system is serviced during the summer months (Timescale 30.08.05 has been reiterated). The vinyl flooring in the bathroom and toilets near to bedroom 5 must be replaced. The lounge chairs must be assessed and be replaced in order of priority (Timescale 30.06.05 has been extended). The paraquet (wooden) flooring in the communal areas must be made safe where loose boards
F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Timescale for action 26th August 2005 2. 18 7 26th July 2005 26th July 2005 3. 19 23 4. 19 13 30th August 2005 5. 6. 19 19 23 23 30th September 2005 30th September 2005 30th August 2005
Page 23 7. 19 13 Overton House Version 1.30 are apparent. 8. 9. 29 37 19 17 Criminal Record Bureau checks must continue to be applied for for all staff. Records required by Regulation 17 of The Care Homes Regulations 2001 must be kept up to date and accurate and constructed and maintained in an appropriate format (Timescale 27.05.05 not met). The hot water temperatures throughout the home accessible and used by residents must be checked on a regular basis and maintained at 43 degrees C and no more than 44 degrees C. A record of water temperatures must be maintained. 30th August 2005 30th August 2005 10. 38 13 26th July 2005 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 23 28 Good Practice Recommendations Consideration should be given as to the future use of one shared room that falls below the required 16sq. m (e.g. convert to single room with an en-suite facility). A minimum ratio of 50 trained members of care staff (NVQ level 2 or equivalent) must be achieved by the end of 2005. Overton House F55 F05 s21573 Overton House V231654 D080605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 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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